RESUMO
PURPOSE: Hepatoblastoma is the most common primary neoplasm of the liver in the pediatric population, usually diagnosed during the first 5 years of life. Patients with large or peripheral hepatoblastomas are at risk for rupture and peritoneal hemorrhage. Image-guided, minimally invasive interventions are offered for controlling hemorrhage. CASE PRESENTATION: We present a 2-year-old female with an 11.8 cm hepatoblastoma in the right hepatic lobe involving segment 4A, who developed hemodynamic instability on day 8 of induction chemotherapy. Imaging revealed intraperitoneal hemorrhage secondary to her ruptured hepatoblastoma. The patient was successfully treated by celiac artery angiogram and transarterial bland embolization. CONCLUSION: Transarterial bland embolization of large hepatoblastomas may control and even prevent intraperitoneal/intracapsular hemorrhage, and may also enhance the efficacy of systematic chemotherapy in the pediatric patients with advanced hepatoblastoma.
RESUMO
INTRODUCTION: To assess impact of size of regions-of-interest (ROI) on differentiation of RCC and renal cysts using multi-phase CT, with focus on differentiating papillary RCC (pRCC) and cysts given known hypovascularity of pRCC. METHODS: 99 renal lesions (23 pRCC, 47 clear-cell RCC, 7 chromophobe RCC, 22 cysts) underwent multi-phase CT. Subjective presence of visual enhancement was recorded for each lesion. Whole-lesion (WL) ROIs, and small (≤ 5 mm(2)), medium (average size of small and large ROIs), and large (half of lesion diameter) peripherally located partial-lesion (PL) ROIs, were placed on non-contrast and nephrographic phases. Impact of ROI size in separating cysts from all RCC and from pRCC based on increased attenuation between phases was assessed using ROC analysis. RESULTS: Visual enhancement was perceived in 96% of ccRCC, 61% of pRCC, and 9% of cysts. AUCs for separating all RCC and cysts for WL-ROI and small, medium, and large PL-ROIs were 91%, 96%, 91% and 93%, and among lesions without visible enhancement were 60%, 79%, 67% and 67%. AUCs for separating pRCC and cysts for WL-ROI and small, medium, and large PL-ROIs were 78%, 92%, 82% and 84%, and among lesions without visible enhancement were 64%, 88%, 69% and 69%. CONCLUSION: Small PL-ROIs had higher accuracy than WL-ROI or other PL-ROIs in separating RCC from cysts, with greater impact in differentiating pRCC from cysts and differentiating lesions without visible enhancement. Thus, when evaluating renal lesions using multi-phase CT, we suggest placing small peripheral ROIs for highest accuracy in distinguishing renal malignancy and benign cysts.