RESUMO
AIM: Patients with Crohn's disease (CD) are at higher risk of small bowel adenocarcinoma (SBA). We aimed to identify radiological predictors of SBA in CD. METHODS: We conducted a retrospective case-control study at two tertiary inflammatory bowel disease centers and identified CD patients diagnosed with SBA between 2003 and 2019. Patients were matched with up to four controls. Pre-operative imaging (magnetic resonance imaging (MRI) or computed tomography (CT)) were reviewed by three gastrointestinal radiologists. RESULTS: Nineteen patients with CD-associated SBA with a mean age of 54.9 and 32 matched controls were included. Mean length of small bowel involvement was 216 (± 188) mm in the SBA group versus 156 (± 167) mm in the control group (p = 0.76). Only 11.8 % of cases had a diagnosis of SBA made preoperatively. In univariate analysis, focal loss of mural stratification (odds ratio [OR], 11; 95%CI, 2.43-49.5, p = 0.002), and wall thickening (OR, 1.32; 95%CI, 1.05-1.66, p = 0.02) were significantly associated with SBA. After adjustment, focal loss of mural stratification was the only independent risk factor (OR, 11; 95 % CI, 2.43-49.5, p = 0.002). CONCLUSIONS: Focal loss of mural stratification was identified as a predictor of CD-associated SBA, which should be described in imaging reports and further validated.
Assuntos
Adenocarcinoma , Doença de Crohn , Neoplasias Duodenais , Neoplasias do Íleo , Humanos , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Estudos Retrospectivos , Estudos de Casos e Controles , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/etiologia , Neoplasias do Íleo/patologia , Neoplasias Duodenais/patologia , Imageamento por Ressonância Magnética , Adenocarcinoma/patologiaAssuntos
Colecistite/parasitologia , Vesícula Biliar/parasitologia , Schistosoma/isolamento & purificação , Esquistossomose/parasitologia , Animais , Biópsia , Colecistectomia , Colecistite/diagnóstico por imagem , Colecistite/cirurgia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Praziquantel/uso terapêutico , Esquistossomose/complicações , Esquistossomose/diagnóstico por imagem , Esquistossomose/terapia , Esquistossomicidas/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia DopplerAssuntos
Doenças do Tecido Conjuntivo/diagnóstico , Equinococose/diagnóstico , Echinococcus granulosus/isolamento & purificação , Tela Subcutânea/parasitologia , Idoso , Albendazol/uso terapêutico , Animais , Antiprotozoários/uso terapêutico , Doenças do Tecido Conjuntivo/tratamento farmacológico , Doenças do Tecido Conjuntivo/parasitologia , Doenças do Tecido Conjuntivo/cirurgia , Equinococose/tratamento farmacológico , Equinococose/parasitologia , Equinococose/cirurgia , Echinococcus granulosus/efeitos dos fármacos , Echinococcus granulosus/parasitologia , Humanos , Masculino , Neoplasias/diagnóstico , Neoplasias/diagnóstico por imagem , CintilografiaRESUMO
OBJECTIVES: To evaluate the reliability of attenuation values of the liver parenchyma and focal liver lesions on virtual unenhanced images from arterial (VUEart) and portal venous phases (VUEport) compared to native unenhanced (NU) attenuation values in patients referred for assessment of malignant liver lesions. METHODS: Seventy-three patients with confirmed primary or metastatic liver tumors who underwent a multiphase contrast-enhanced rapid-switching kVp dual-energy CT (rsDECT) were included in this IRB-approved retrospective study. Both qualitative and quantitative analyses - including the lesion-to-liver contrast-to-noise ratio (LL-CNR) - were performed and compared between NU and both VUEart and VUEport images. RESULTS: The mean liver attenuation values were significantly lower in VUEart images (56.7⯱â¯6.7 HU) than in NU images (59.6⯱â¯7.5 HU, pâ¯=â¯0.008), and were comparable between VUEart and VUEport images (57.9⯱â¯6 UH, pâ¯=â¯0.38) and between VUEport and NU images (pâ¯=â¯0.051). The mean liver lesions attenuation values were comparable between NU, VUEart and VUEport images (pâ¯=â¯0.60). Strong and significant correlations values were found both in liver lesions and tumor-free parenchyma (râ¯=â¯0.82-0.91, pâ¯<â¯0.01). The mean LL-CNR was significantly higher in VUEart and VUEport images than in NU images (1.7⯱â¯1 and 1.6⯱â¯1.1 vs 0.9⯱â¯0.6; pâ¯<â¯0.001), but was comparable between VUEart and VUEport images (pâ¯>â¯0.9). Lesion conspicuity was significantly higher in VUEport images than in NU images (pâ¯<â¯0.001). CONCLUSION: VUEport images derived from 3rd generation rsDECT could confidently replace NU images in patients undergoing assessment for malignant liver lesions. These images provide comparable attenuation values in both liver lesions and liver parenchyma while reducing the radiation dose and scanning time.
Assuntos
Neoplasias Hepáticas , Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Meios de Contraste , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion for which imaging diagnosis remains a challenge. We report the case of a 39-year-old Algerian woman, who presented epigastric pains combined with fever and jaundice. Ultrasound, CT scan and MRI showed the presence of a 10 cm-long multi-septated cystic mass of the left lobe, with peripheral enhancement. A left-hepatectomy was performed and histopathology revealed an IPT of the liver. During the 4 following years, the patient had three other recurrences of liver IPT at various locations distinct from the original, revealed by the same clinical symptoms. During these relapses, the lesions did regress thanks to a medical treatment. This observation underlines the difficulty of the diagnosis and treatment of liver IPT.
Assuntos
Granuloma de Células Plasmáticas/diagnóstico , Hepatopatias/diagnóstico , Dor Abdominal/etiologia , Adulto , Anti-Inflamatórios/uso terapêutico , Diagnóstico por Imagem , Feminino , Febre/etiologia , Granuloma de Células Plasmáticas/terapia , Hepatectomia , Humanos , Icterícia/etiologia , Hepatopatias/terapia , Prednisolona/uso terapêutico , RecidivaRESUMO
Diffusion-Weighted-Imaging (DWI) assesses proton motion on a cellular scale. Owing to recent instrumentation developments, diffusion sequences are now routinely used for liver imaging. This review will go through the physical principles that underlie this technique, and then highlight up-to-date liver applications including quantification of liver fibrosis, focal lesions detection and characterization, and therapy response monitoring.