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OBJECTIVE. This systematic review presents evidence-based consensus statements as reported by a multidisciplinary expert panel (six abdominal radiologists, four hepatobiliary surgeons, and two hepatologists) regarding the use of gadoxetic acid for liver MRI. CONCULSION. Although this review highlights the incremental diagnostic value of hepatobiliary phase imaging with gadoxetic acid-enhanced liver MRI in multiple clinical scenarios, there remains a need for further impact studies for some clinical applications, such as hepatocellular carcinoma in cirrhosis.
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Medios de Contraste , Gadolinio DTPA , Hepatopatías/diagnóstico , Imagen por Resonancia Magnética/métodos , Consenso , Humanos , Comunicación Interdisciplinaria , Guías de Práctica Clínica como AsuntoAsunto(s)
Enfisema/diagnóstico por imagen , Hepatitis/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Medios de Contraste , Diagnóstico Diferencial , Enfisema/microbiología , Resultado Fatal , Hepatitis/microbiología , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/microbiología , Tomografía Computarizada por Rayos XRESUMEN
A 58-year-old man with metastatic clear cell renal cell carcinoma on sunitinib therapy, who previously failed on sorafenib, was found to have progression of multiple hepatic metastases; he was on a standard sunitinib dose of 50 mg/day (4 weeks on, 2 weeks off). Due to the unavailability of alternative therapies, a sunitinib dose escalation of 50 mg/day was attempted. After one 6-week cycle of continuously dosed sunitinib 50 mg, the hepatic lesions regressed. After the second cycle, virtual disappearance of the lesions was recorded. There was no added toxicity. These findings suggest that sunitinib dose escalation to 50 mg/day using continuous daily administration dosing might represent a valid, effective and well-tolerated therapeutic option in patients who progress on standard sunitinib therapy.
RESUMEN
A 75-yr-old previously healthy woman presented with gross hematuria, European Cooperative Oncology Group 0, and an 11-cm renal mass with right atrial thrombus. The patient refused the sternotomy. She was offered two cycles of sunitinib maleate (Sutent) induction therapy to down-stage the thrombus and to reduce the extent of the surgery.
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Antineoplásicos/uso terapéutico , Carcinoma de Células Renales/tratamiento farmacológico , Trombosis Coronaria/prevención & control , Indoles/uso terapéutico , Neoplasias Renales/tratamiento farmacológico , Pirroles/uso terapéutico , Anciano , Carcinoma de Células Renales/complicaciones , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/etiología , Diagnóstico Diferencial , Femenino , Atrios Cardíacos , Humanos , Neoplasias Renales/complicaciones , Imagen por Resonancia Magnética , Terapia Neoadyuvante , Sunitinib , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
CONTEXT: Computed tomography is widely used to pre-operatively evaluate patients with ductal carcinoma of the pancreas. OBJECTIVE: To prospectively evaluate the ability of multi-detector computed tomography to predict resectability of pancreatic head cancer. PATIENTS: Ninety-one consecutive patients (53 men, 38 women; mean age, 61 years) referred to our department with a diagnosis of cancer of the head of the pancreas underwent a preoperative contrast enhanced triphasic 16-slice multi-detector computed tomography. Sixty-three were considered inoperable because of advanced local disease, metastatic disease, or poor surgical risk. INTERVENTION: Of the remaining 28 patients, 23 underwent a Whipple procedure, whereas 5 patients underwent a palliative procedure. MAIN OUTCOME MEASURES: Surgical and pathologic reports were reviewed and compared to CT results. RESULTS: Of the 91 patients evaluated, 25% had successful resection of pancreatic head carcinoma; while only 5% had a palliative procedure. When compared to surgical outcome, the positive predictive value of multi-detector computed tomography for resectability was 100%. On the basis of pathologic results, the positive predictive value of multi-detector computed tomography for resectability fell to 83%, Four patients deemed resectable following multi-detector computed tomography had positive margins at pathology. CONCLUSION: The positive predictive value of multi-detector computed tomography for resectable disease is lower when pathologic correlation, as opposed to surgical correlation, is used as the gold standard. Compared to previous studies, there was a lower rate of palliative surgery in our cohort.
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Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/cirugía , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugía , Tomografía Computarizada Espiral/métodos , Adenocarcinoma/patología , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/patología , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
OBJECTIVE: The records of 10 patients with focal nodular hyperplasia inducing intrahepatic vein obstruction were reviewed. The purpose of this study was to describe and emphasize the imaging features of these findings. CONCLUSION: Focal nodular hyperplasia may be responsible for hepatic vein obstruction with hepatic vein collaterals. The relatively large size and central location of the lesions seem to play important roles in the obstruction of the hepatic veins.
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Hiperplasia Nodular Focal/complicaciones , Hiperplasia Nodular Focal/diagnóstico , Enfermedad Veno-Oclusiva Hepática/diagnóstico , Enfermedad Veno-Oclusiva Hepática/etiología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Circulación Colateral/fisiología , Femenino , Hiperplasia Nodular Focal/fisiopatología , Enfermedad Veno-Oclusiva Hepática/fisiopatología , Humanos , Circulación Hepática/fisiología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The contribution of radio-guided transcutaneous biopsy in the diagnosis of focal nodular hyperplasia (FNH) of the liver was compared with the findings on surgical specimens to assess its contribution in clinical and radiologic atypical cases. This retrospective study involved 30 patients with atypical tumors on imaging who underwent liver biopsy and then surgery. All surgical specimens were diagnosed as FNH, either classical (n = 18) or nonclassical (n = 12). Imaging data were reviewed according to 4 radiologic criteria on magnetic resonance imaging (MRI) and/or computed tomography (CT) scan (hypervascularity, homogeneity, nonencapsulation, and presence of a central scar), and classified depending on the number of criteria found (group I, 4 of 4; group II, 3 of 4; group III, 2 or fewer). Histologic assessment of ultrasound (US)-guided liver biopsy recorded major diagnostic features (fibrous bands, thick-walled vessels, reactive ductules, and nodularity) and minor features (sinusoidal dilatation and perisinusoidal fibrosis). "Definite FNH" (3 or 4 major features) was diagnosed in 14 biopsies, "possible FNH" (2 major and 1 or 2 minor features) in 7 cases, and "negative for FNH" (2 or fewer major features without minor features) in 9 cases. The diagnosis of FNH on biopsy was reached in 14 cases (58.3%) in patients with 2 or fewer imaging criteria (group III; n = 24). Biopsies with a diagnosis of "possible FNH" corresponded to a large proportion of telangiectatic-type FNH on the specimen. In conclusion, liver biopsy does not appear to be necessary in cases in which imaging is typical. However, the absence of radiologic diagnostic criteria in FNH does not preclude a positive diagnosis on liver needle biopsy. Using the proposed histologic scoring system, surgical management may be avoided in these cases.