Prognostic role of magnetic resonance imaging of the abdomen with intravenous contrast and magnetic resonance cholangiopancreatography in primary sclerosing cholangitis / Papel prognóstico da ressonância magnética do abdome com contraste intravenoso e colangiopancreatografia por ressonância magnética na colangite esclerosante primária

Abstract Objective: To evaluate the usefulness of Anali scores, determined by magnetic resonance imaging, for predicting the prognosis of primary sclerosing cholangitis (PSC) and to analyze interobserver variability, as well as to assess the impact of periportal edema and heterogeneous signal intensity on diffusion-weighted imaging of the liver. Materials and Methods: This was a retrospective cohort study of 29 patients with PSC and baseline magnetic resonance imaging. Anali scores, without gadolinium (0-5 points) and with gadolinium (0-2 points), were calculated by two radiologists. Clinical end-points included liver transplantation, cirrhotic decompensation, and death. We calculated intraclass correlation coefficients (ICCs) for interobserver agreement on the Anali scores, performed Kaplan-Meier survival analysis comparing event-free survival among the score strata, and calculated the areas under receiver operating characteristic curves to determine sensitivity and specificity. Results: Among the patients with a clinical event, the median Anali score was 4 (interquartile range [IQR], 2-5) without gadolinium and 2 (IQR, 1-2) with gadolinium, compared with 1 (IQR, 1.0-2.5) and 1 (IQR, 0.25-1.0), respectively, among those without a clinical event. The ICC was 0.79 (95% confidence interval: 0.57-0.91) for the Anali score with gadolinium and 0.99 (95% confidence interval: 0.98-0.99) for the Anali score without gadolinium. Periportal edema and heterogeneous signal intensity in the liver on diffusion-weighted imaging showed no statistical impact on clinical events (p = 0.65 and p = 0.5, respectively). Conclusion: Anali scores correlate with clinical events in PSC, with a high level of interobserver agreement.

Resumo Objetivo: Avaliar a utilidade dos escores Anali determinados por ressonância magnética para prever o prognóstico da colangite esclerosante primária (CEP), analisar a variabilidade interobservador e avaliar o impacto do edema periportal e do sinal heterogêneo do fígado em imagens ponderadas por difusão. Materiais e Métodos: Estudo retrospectivo de coorte de 29 pacientes com CEP e ressonância magnética de base. Os escores Anali sem gadolínio (0 a 5 pontos) e com gadolínio (0 a 2 pontos) foram calculados por dois radiologistas. Os desfechos clínicos incluíram transplante de fígado, descompensação cirrótica ou morte. Foram realizados coeficiente de correlação intraclasse (CCI) para a concordância interobservador com relação ao escore Anali, análise de sobrevivência de Kaplan-Meier comparando o tempo livre de eventos de acordo com o escore, e área sob a curva característica de operação do receptor para sensibilidade e especificidade. Resultados: Nos pacientes com evento clínico, a mediana do escore Anali sem gadolínio foi 4 (intervalo interquartil [IIQ]: 2-5) e com gadolínio foi 2 (IIQ: 1-2), enquanto nos pacientes sem evento clínico o escore sem gadolínio foi 1 (IIQ:1-2,5) e com gadolínio foi 1 (IIQ: 0,25-1). A concordância interobservador com gadolínio foi CCI = 0,79 (intervalo de confiança 95%: 0,57-0,91) e sem gadolínio foi CCI = 0,99 (intervalo de confiança 95%: 0,98-0,99). O edema periportal (p = 0,65) e o sinal heterogêneo do fígado nas imagens ponderadas por difusão (p = 0,5) não apresentaram impacto nos eventos clínicos. Conclusão: Os escores Anali se correlacionam com eventos clínicos na CEP, com alto grau de concordância interobservador.

Radiomics and Machine Learning for prediction of two-year disease-specific mortality and KRAS mutation status in metastatic colorectal cancer.

PURPOSE: Colorectal cancer is usually accompanied by liver metastases. The prediction of patient evolution is essential for the choice of the appropriate therapy. The aim of this study is to develop and evaluate machine learning models to predict KRAS gene mutations and 2-year disease-specific mortality from medical images. METHODS: Clinical and follow-up information was collected from patients with metastatic colorectal cancer who had undergone computed tomography prior to liver resection. The dominant liver lesion was segmented in each scan and radiomic features were extracted from the volumes of interest. The 65% of the cases were employed to perform feature selection and to train machine learning algorithms through cross-validation. The best performing models were assembled and evaluated in the remaining cases of the cohort. RESULTS: For the mortality model development, 101 cases were used as training set (64 alive, 37 deceased) and 35 as test set (22 alive, 13 deceased); while for KRAS mutation models, 55 cases were used for training (31 wild-type, 24 mutated) and 30 for testing (17 wild-type, 13 mutated). The ensemble of top performing models resulted in an area under the receiver operating characteristic curve of 0.878 for mortality and 0.905 for KRAS prediction. CONCLUSIONS: Predicting the prognosis of patients with metastatic colorectal cancer is useful for making timely decisions about the best treatment options. This study presents a noninvasive method based on quantitative analysis of baseline images to identify factors influencing patient outcomes, with the aim of incorporating these tools as support systems.

Imaging assessment after pancreaticoduodenectomy: reconstruction techniques-normal findings and complications.

Pancreaticoduodenectomy represents a major surgery for tumors located at the pancreatic head and the ampullary/periampullary region. This complex procedure is associated with a high morbidity rate. Many surgical techniques have been proposed in order to reduce mortality rates, although post-procedure complications represent a current problem. Different imaging findings and complications may appear depending on the surgical technique used. Hence, radiologists should be familiarized with them to distinguish normal findings from real complications. The most challenging scenarios are represented by abdominal fluid collections, and tumor recurrence, that may frequently mimic normal postsurgical changes.

[Epidemiology of patients with hepatocellular carcinoma in a University hospital]. / Epidemiología de pacientes con hepatocarcinoma en un Hospital Universitario.

Hepatocellular carcinoma is the most common primary liver tumor, with 905 677 diagnosed cases and 830 180 deaths, in 2020 worldwide. In Argentina, it accounts for the 9th cause of death for cancer in men and the 10th in women. Unlike other highly-prevalent tumors, scientific evidence for most therapeutic options is limited mainly to small cohorts and retrospective studies. The aim of this study is to characterize and describe epidemiologically patients with diagnosis of hepatocellular carcinoma in the Italian Hospital of Buenos Aires during a 12-year period. Overall survival for our cohort was 58%, 46%, and 36% at 1, 3 and 5 years respectively. Average survival for patients receiving palliative treatment was 5 months, while for those who received either non-curative or curative treatment was 23 and 75 months respectively. Recurrence-free survival for those patients who underwent a curative treatment was 89%, 76% y 61% at 1, 3 and 5 years. A thorough analysis of etiology, risk factors, incidence, mortality and treatment was made. The study's importance lies in its large sample size, quantity and quality of data, and will most certainly stimulate the development of local studies in hepatocellular carcinoma.

El carcinoma hepatocelular (HCC) es el tumor primario más frecuente del hígado, con 905 677 casos diagnosticados en 2020, en todo el mundo, y 830 180 muertes. Es responsable de la novena causa de muerte por cáncer en los hombres y la décima en mujeres en Argentina. A diferencia de otros tumores de alta prevalencia, la evidencia científica acerca del HCC se limita principalmente a pequeñas cohortes y estudios retrospectivos. El objetivo de este estudio fue describir epidemiológicamente a aquellos pacientes con diagnóstico de HCC en el Hospital Italiano de Buenos Aires en un periodo de 12 años. La supervivencia global para nuestra cohorte fue de 58, 46 y 36% a 1, 3 y 5 años respectivamente. El promedio de supervivencia en pacientes con tratamiento paliativo fue de 5 meses, 23 para aquellos que recibieron tratamientos no curativos y 75 meses para los que recibieron tratamientos curativos. El porcentaje de pacientes libres de enfermedad a 1, 3 y 5 años fue de 89%, 76% y 61% respectivamente. Se realizó un estudio minucioso de la etiología, factores de riesgo, incidencia, mortalidad y tratamientos realizados. Su importancia yace en su tamaño muestral, calidad y cantidad de información disponible.

Epidemiología de pacientes con hepatocarcinoma en un hospital Universitario / Epidemiology of patients with hepatocellular carcinoma in a University hospital

Resumen El carcinoma hepatocelular (HCC) es el tumor primario más frecuente del hígado, con 905 677 casos diagnosticados en 2020, en todo el mundo, y 830 180 muertes. Es responsable de la novena causa de muerte por cáncer en los hombres y la décima en mujeres en Argentina. A diferencia de otros tumo res de alta prevalencia, la evidencia científica acerca del HCC se limita principalmente a pequeñas cohortes y estudios retrospectivos. El objetivo de este estudio fue describir epidemiológicamente a aquellos pacientes con diagnóstico de HCC en el Hospital Italiano de Buenos Aires en un periodo de 12 años. La supervivencia global para nuestra cohorte fue de 58, 46 y 36% a 1, 3 y 5 años respectivamente. El promedio de supervivencia en pacientes con tratamiento paliativo fue de 5 meses, 23 para aquellos que recibieron tratamientos no curativos y 75 meses para los que recibieron tratamientos curativos. El porcentaje de pacientes libres de enfermedad a 1, 3 y 5 años fue de 89%, 76% y 61% respectivamente. Se realizó un estudio minucioso de la etiología, factores de riesgo, incidencia, mortalidad y tratamientos realizados. Su importancia yace en su tamaño muestral, calidad y cantidad de información disponible.

Abstract Hepatocellular carcinoma is the most common primary liver tumor, with 905 677 diagnosed cases and 830 180 deaths, in 2020 worldwide. In Argentina, it accounts for the 9th cause of death for cancer in men and the 10th in women. Unlike other highly-prevalent tumors, scientific evidence for most therapeutic options is limited mainly to small cohorts and retrospective studies. The aim of this study is to characterize and describe epidemiologically patients with diagnosis of hepatocellular carcinoma in the Italian Hospital of Buenos Aires during a 12-year period. Overall survival for our cohort was 58%, 46%, and 36% at 1, 3 and 5 years respectively. Average survival for patients receiving palliative treatment was 5 months, while for those who received either non-curative or curative treatment was 23 and 75 months respectively. Recurrence-free survival for those patients who under went a curative treatment was 89%, 76% y 61% at 1, 3 and 5 years. A thorough analysis of etiology, risk factors, incidence, mortality and treatment was made. The study's importance lies in its large sample size, quantity and quality of data, and will most certainly stimulate the development of local studies in hepatocellular carcinoma.

Hydatid liver disease with portal vein invasion, cavernous transformation and portal biliopathy.

Hydatid disease is a zoonotic parasitic disease, most commonly affecting the liver, lungs and nervous system. Portal vein involvement by hydatid cyst disease is very rare with only few cases published to our knowledge. We describe a case involving a 53-year-old woman with portal vein invasion, cavernous transformation and portal biliopathy.

Sarcopenia HIBA score predicts sarcopenia and mortality in patients on the liver transplant waiting list.

Sarcopenia is a prevalent condition that predicts prognosis in patients awaiting liver transplantation (LT). The gold standard for the diagnosis of sarcopenia is the assessment of the muscular area at L3 with computed tomography (CT) scan (skeletal muscle index [SMI]), but the routine use of CT scan is limited in clinical practice. Thus, we designed a single-center observational study aimed to evaluate the clinical factors associated with the presence of sarcopenia by SMI, and to build a score capable of predicting or excluding the presence of sarcopenia in patients on the LT waiting list (WL). Binary logistic regression analysis was performed to establish the factors independently associated with sarcopenia, and the Sarcopenia Hospital Italiano de Buenos Aires (HIBA) score was built from the resulting model after internal validation analysis by bootstrapping and correction for optimism. The predictive capability of mortality on the WL was evaluated with competing risk regression analysis. A total of 215 patients with cirrhosis on the LT WL were included. The independent factors associated with the presence of sarcopenia were male sex (odds ratio [OR]: 6.09, p < 0.001), body mass index (OR: 0.74, p < 0.001), Child Pugh (OR: 1.44, p < 0.001), and the ratio creatinine/Cystatin C (OR: 0.03, p = 0.007). The Sarcopenia HIBA score constructed with these variables showed an area under the curve of 0.862. During follow-up, 77 (36%) patients underwent LT, 46 (21%) died, and 92 (43%) remained alive. After adjusting for Model for End-Stage Liver Disease-Sodium, Sarcopenia HIBA score was an independent predictor of WL mortality (subhazard ratio: 1.19; 95% confidence interval 1.01-1.40; p = 0.042). Sarcopenia HIBA score is an easy-to-use, objective, and reliable diagnostic and predictive tool that can be useful to improve the prognostic evaluation and allow identifying a group of patients with a higher risk of death while awaiting LT.

Anomalía de la unión biliopancreática: una entidad infrecuente en Occidente / Pancreaticobiliary maljunction: a rare entity in the West

Resumen La anomalía de la unión biliopancreática (AUBP) es una malformación congénita en la que los conductos pancreáticos y biliares se unen anatómicamente fuera de la pared duodenal. Debido a la excesiva longitud del canal común, la acción del esfínter no afecta la unión pancreatobiliar, lo que permite el reflujo del jugo pancreático hacia la vía biliar. Se asocia con quistes del colédoco y sus manifestaciones incluyen cáncer de la vía biliar, pancreatitis, coledocolitiasis y colangitis. Es una rara patología, especialmente en países occidentales. La colangiopancreatografía por resonancia magnética (CPRM) se ha convertido en el método más utilizado por no ser invasivo, teniendo en cuenta que la colangiopancreatografía retrógrada endoscópica (CPRE) se encuentra contraindicada en casos de pancreatitis aguda y colangitis, además del riesgo de pancreatitis posterior al procedimiento. La distancia entre la unión biliopancreática y la pared duodenal debe ser superior a 9 mm de longitud para diagnosticar AUBP mediante CPRM. En caso de que mida entre 6 y 9 mm y la acción del esfínter afecte la unión pancreatobiliar, se lo denomina unión biliopancreática alta (UBPA) y se debe confirmar mediante CPRE. Describimos los hallazgos en imágenes de siete pacientes jóvenes con clínica abdominal y diagnóstico de AUBP o UBPA por CPRM, y además revisamos la literatura sobre el tema.

Abstract Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and biliary ducts are anatomically joined outside the duodenal wall. Due to the excessive length of the common channel, the action of the sphincter does not affect the pancreaticobiliary junction, allowing the reflux of pancreatic juice into the bile duct. It is associated with cysts of the common bile duct and its manifestations include cancer of the bile duct, pancreatitis, choledocholithiasis and cholangitis. It is a rare pathology, especially in Western countries. Magnetic resonance cholangiopancreatography (MRCP) has become the most used method because it is non-invasive, taking into account that endoscopic retrograde cholangiopancreatography (ERCP) is contraindicated in cases of acute pancreatitis and cholangitis, in addition to the risk of pancreatitis after the procedure. The distance between the biliopancreatic junction and the duodenal wall must be greater than 9 mm in length to diagnose PBM by MRCP. If it is between 6 to 9 mm and the action of the sphincter affects the pancreaticobiliary junction, it is called high confluence of pancreaticobiliary ducts (HCPBD) and should be confirmed by ERCP. We describe the imaging findings of 7 young patients with abdominal symptoms and diagnosis of PBM or HCPBD by MRCP, and also review the literature on the subject.

Assessment of SE-MRE-derived shear stiffness at 3.0 Tesla for solid liver tumors characterization.

OBJECTIVES: To evaluate the feasibility and diagnostic value of using a 2D spin-echo MR elastography (SE-MRE) sequence at 3.0 Tesla for solid focal liver lesions (FLL) characterization. METHODS: This prospective study included 55 patients with solid FLL (size > 20 mm), who underwent liver SE-MRE at 3 Tesla between 2016 and 2019. Stiffness measurements were performed by two independent readers blinded to the complete MRI exam or patient information. Histological confirmation or typical behavior on the complete MRI exam evaluated in consensus by expert abdominal radiologists was used as reference standard. FLLs were grouped and compared (malignant vs. benign) using the Mann-Whitney and Kruskal-Wallis tests. MRE diagnostic performance was assessed, and stiffness cutoffs were obtained by analysis of ROC curves from accuracy maximization. A linear regression plot was used to evaluate inter-rater agreement for FLLs stiffness measurements. p values < 0.05 were considered statistically significant. RESULTS: The final study group comprised 57 FLLs (34 malignant, 23 benign). Stiffness measurements were technically successful in 91.23% of lesions. To both readers, the median stiffness of the lesions categorized as benign was 4.5 ± 1.5 kPa and in the malignant group 6.8 ± 1.7 and 7.5 ± 1.5 kPa depending on the reader. A cutoff of 5.8 kPa distinguished malignant and benign lesions with 88% specificity and 75-85% accuracy depending on the reader. The inter-rater agreement was 0.90 ± 0.04 with a correlation coefficient of 0.94. CONCLUSION: 2D-SE-MRE at 3.0 T provides high specificity and PPV to differentiate benign from malignant liver lesions. Trial registration 18FFUA-A02.

Argentinian clinical practice guideline for surveillance, diagnosis, staging and treatment of hepatocellular carcinoma.

The A.A.E.E.H has developed this guideline for the best care of patients with hepatocellular carcinoma (HCC) from Argentina. It was done from May 2018 to March 2020. Specific clinical research questions were systematically searched. The quality of evidence and level of recommendations were organized according to GRADE. HCC surveillance is strongly recommended with abdominal ultrasound (US) every six months in the population at risk for HCC (cirrhosis, hepatitis B or hepatitis C); it is suggested to add alpha-feto protein (AFP) levels in case of inexeperienced sonographers. Imaging diagnosis in patients at risk for HCC has high specificity and tumor biopsy is not mandatory. The Barcelona Clinic Liver Cancer algorithm is strongly recommended for HCC staging and treatment-decision processes. Liver resection is strongly recommended for patients without portal hypertension and preserved liver function. Composite models are suggested for liver transplant selection criteria. Therapies for HCC with robust clinical evidence include transarterial chemoembolization (TACE) and first to second line systemic treatment options (sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). Immunotherapy with nivolumab and pembrolizumab has failed to show statistical benefit but the novel combination of atezolizumab plus bevacizumab has recently shown survival benefit over sorafenib in frontline.

Cystatin C and Sarcopenia Predict Acute on Chronic Liver Failure Development and Mortality in Patients on the Liver Transplant Waiting List.

BACKGROUND: Cystatin C (CysC) is an early biomarker of renal dysfunction scarcely studied in patients awaiting liver transplantation (LT). Sarcopenia is frequent in cirrhosis and impacts prognosis. We aimed to assess the capability of these factors to predict survival and acute-on-chronic liver failure (ACLF) in patients awaiting LT, as well as early post-LT outcomes. METHODS: Single-center study that included all cirrhotic patients listed for LT between 2014 and 2017. Competing risk regression analysis was used to evaluate the capability of liver-, kidney-, and global status-related variables at waitlist (WL) inclusion to predict WL mortality and ACLF. Variables associated with post-LT outcomes were evaluated with logistic regression analysis. RESULTS: One-hundred-and-eighty patients were included. Fifty-six (31%) patients developed ACLF, 54 (30%) underwent LT and 35 (19%) died. In the adjusted competing risk regression analysis, CysC ≥ 1.5 mg/L, sarcopenia and MELD-Na were independent predictors of ACLF in the WL, while CysC ≥ 1.5 mg/L, sarcopenia and albumin were independent predictors of mortality. The cumulative incidence of ACLF and mortality at 12 months were 50% and 34% in patients with sarcopenia and CysC ≥1.5 mg/L. An estimated glomerular filtration rate by chronic kidney disease (CKD)-EPI-CysC-creatinine <60 mL/min/1.73 m at WL inclusion was an independent predictor of the need for renal replacement therapy (RRT) in the first month post-LT. CONCLUSIONS: Higher levels of CysC and sarcopenia are strongly associated with the ACLF and mortality in WL. The assessment of both risk factors may improve the prognostic evaluation and allow identifying a group of patients with a very high risk of poor outcomes while awaiting LT.

Hepatic metastasis of thymoma: case report and immunohistochemical study.

Thymomas are rare tumours characterised by their slow growth and capacity to invade directly by contiguity. While distant dissemination is infrequent, all sub-types of thymoma have the capacity to metastasise to extrathoracic organs. We present here the case of a female patient with a liver mass discovered 13 years after the removal of a mediastinal thymoma and after ten years from thyroidectomy for papillary carcinoma. The histopathological study showed that the lesion contained an epithelial component, which was immunohistochemically positive for pankeratin. It was accompanied by numerous small lymphocytes testing positive for TdT, CD3, CD4, CD5, CD8, CD99, and CD43. The result was consistent with hepatic metastatic thymoma sub-type B1, according to the World Health Organisation classification (WHO). Our case highlights the importance of morphological and immunohistological examinations in the differential diagnosis of visceral masses in patients with a history of thymoma. Given the infrequency of its metastasis and the increased risk of developing other primary tumours that these patients have, these studies play a significant role.

Focal nodular hyperplasia and hepatic adenoma: current diagnosis and management.

Benign liver tumors are common lesions that can be classified into cystic and solid lesions. Cystic lesions are the most frequent; however, they rarely represent a diagnostic or therapeutic challenge. In contrast, solid lesions are more difficult to characterize and management remains controversial. The wide availability and use of advanced imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging have led to increased identification of incidental liver masses. Although some of these incidentally discovered masses are malignant, most are benign and must be included in the differential diagnosis. In this article we review FNH and HA. Its etiology, biological behavior, diagnosis, and treatment will be highlighted.

MDCT findings after hepatic chemoembolization with DC-beads: what the radiologist needs to know.

Transcatheter arterial chemoembolization with drug-eluting beads (TACE-DC-beads) is a new local treatment for primary or metastatic liver tumors. Despite technical efforts to achieve highly selective embolization of the tumor-supplying vessels, small, or large insults to the non-tumorous parenchyma are inevitably induced by the embolic materials or procedure itself. Parenchymal changes following TACE-DC-beads include bile duct injuries (bile duct dilatation, periportal edema, and bilomas), obliteration of intrahepatic portal vein branches, hypodense ill-defined areas, and perilesional parenchymal enhancement. The radiologist must be familiar with the changes induced by this treatment in order to distinguish therapeutic effect and collateral findings from complications and residual or recurrent tumor.

Manejo del nódulo pulmonar solitario por cirugía videotoracoscópica / Videothorascocpic management of the solitary pulmonare nodule

Introducción: El objetivo de este estudio fue determinar las distintas etiologías delos nódulos pulmonares solitarios (NPS) resecados quirúrgicamente; establecer la rentabilidad diagnóstica y la tasa de complicaciones de la resección videotoracoscópica (VATS) del NPS.Métodos: Se evaluaron 483 pacientes operados de NPS en el Hospital Británico de Buenos Aires entre el período 1987-2008. Los criterios de inclusión para NPS fueron: lesión intrapulmonar menor de 3 cm., rodeada de parénquima sano, no asociada aatelectasia, neumonía y/o adenomegalias.Resultados: El examen patológico de los nódulos resecados mostró 342 (70.8%) lesiones malignas y 141(29.2%) lesiones benignas. Entre las lesiones benignas los granulomas (48.2%) y hamartomas (22.7%) resultaron ser las principales causas. Los NPS malignos se observaron en pacientes de mayor edad y su tamaño fue mayor (p=<0.001). Sin embargo, no fueron diferentes en cuanto antecedente de tabaquismo (p=0.981) y de neoplasia previa (p= 0.918). La cirugía torácica videoasistida (VATS) se realizó en 238 pacientes (49.3%). La conversión a toracotomía se realizó en 7 casos (8.3%) de los nódulos benignos siendo los motivos principales: la imposibilidad de localizar la lesión ó la necesidad de ampliación de la resección. Se presentaron complicaciones vinculadas a la cirugía videotoracoscópica (VATS) en 8 casos (3.36%). Conclusión: La VATS es un procedimiento de muy baja morbimortalidad en la resección de nódulos benignos. La edad del paciente y el tamaño del nódulo pulmonar resultaron ser factores confiables para predecir la histología maligna.

En las enfermedades intersticiales difusas,¿todos los quistes son realmente quistes? / Diffuse interstitial diseases: are all cysts real cysts?

Propósito: Demostrar que los cortes axiales de tomografía computada de alta resolución (TCAR) son insuficientes para una correcta evaluación de las enfermedades pulmonares intersticiales difusas y que adicionar Proyección de Mínima Intensidad (MinIP) aumenta la especificidad del diagnóstico. Material y Métodos: Estudios previos donde se observaban quistes pequeños subpleurales se seleccionaron 39 TCAR de 33 pacientes con colagenopatías confirmadas y 6 con enfermedad intersticial idiopática y se los reexaminó entre octubre de 2008 y junio de 2009. El equipo utilizado fue un tomógrafo computado multislice Philips Brillance de 16 canales. Los cortes fueron de 1 mm de espesor, de ápices a bases. La evaluación se realizó con la técnica habitual, adicionando la MinIP en cortes axiales, sagitales y coronales, con rotación del parénquima y especial atención en las áreas que presentaban quistes. Se efectuaron además cortes en espiración. Resultados: De 20 TCAR que mostraban quistes subpleurales con la técnica habitual, 14 (70%) correspondieron a bronquioloectasias. En 12 casos, todas las imágenes eran bronquioloectasias; en 2 casos, ellas predominaban, observándose también quistes aislados. Se pudo definir la existencia de quistes verdaderos en 6 casos (30%), todos con Neumonitis Intersticial Usual (NIU). Valor predictivo positivo (VPP) de la TCAR para detección de quistes: 30% (IC95% 0.13-0.54). Conclusiones: Los trabajos publicados sobre enfermedades intersticiales se basan en la evaluación con cortes axiales de TCAR y la demostración de quistes es de suma importancia para diferenciar NIU de la Neumonía Intersticial No Específica (NINE). En este estudio, se evidencia que la utilización de MinIP con rotación del parénquima redefine 70% de los quistes como bronquioloectasias. Dado el rol cardinal de la TCAR en la evaluación de las intersticiopatías, es importante un estudio prospectivo de seguimiento con mayor número de casos que confirme si son los quistes reales y no los redefinidos como bronquioloectasias los que caracterizan a la NIU.

Objective: To demonstrate that axial sections on high-resolution computed tomography (HRCT) are insufficient for an accurate examination of diffuse interstitial lung diseases. To further show that minimum intensity projection (MinIP) increases diagnosis specificity. Material and methods: Preliminary studies reporting small subpleural cysts were used to select 39 HRCT from 33 patients with confirmed collagen diseases and 6 patients with idiopathic interstitial disease. Patients were reexamined between october 2008 and june 2009. A 16-channel Philips Brillance multislice CT scanner was used. Sections were 1 mm thick de apices a bases. Patients were examined using the common technique, including the MinIP for axial, sagittal and coronal sections, with parenchymal rotation. Cystic areas were carefully examined. Spiral sections were also performed. Results: Of 20 HRCT depicting subpleural cysts with the conventional technique, 14 (70%) were bronchiolectases. In 12 cases, images were all bronchiolectases; in the other 2, a prevalence of bronchiolectases and isolated cysts were seen. Real cysts could be confirmed in 6 cases (30%), all of which presented usual interstitial pneumonitis (UIP). The HRCT positive predictive value (PPV) for cyst detection was 30% (95% CI 0.13-0.54). Conclusions: Interstitial diseases reports focus on performing axial sections on HRCT, and cyst detection is pivotal to differentiate UIP from NINE. This study reveals that the use of MinIP with parenchymal rotation redefines 70% of cysts as bronchiolectases. Given the key role of HRCT in the examination of interstitial diseases, it is important to carry out a prospective follow-up study with a larger number of cases, in order to confirm whether the UIP is characterized by real cysts or by cysts redefined as bronchiolectases.

Radiological versus histopathological diagnosis of usual interstitial pneumonia in the clinical practice: does it have any survival difference?

BACKGROUND: Recent studies have shown that quantification of specific histopathologic features found in usual interstitial pneumonia (UIP) are useful in defining a prognosis, suggesting the need of biopsy in all patients. OBJECTIVES: This study examines whether UIP-associated mortality is different in patients diagnosed by high-resolution computed tomography (HRCT) features considered definite of UIP and in patients with no definite radiological diagnosis that required histological confirmation of diagnoses. METHODS: Forty-five patients were included (30 males, mean age 65.3 +/- 10.7 years). Two groups of patients were identified: those with HRCT findings of definite UIP (n = 26) and those whose radiological diagnosis was not definite and required a surgical biopsy to confirm the presence of UIP (n = 19). Forced vital capacity, forced expiratory volume in 1 s and diffusing capacity for carbon monoxide were measured in all patients. All data were obtained from medical records, and the survival status was obtained by telephone or personal interview. All clinical parameters and HRCTs were obtained within 1 month before surgical lung biopsy. RESULTS: Median survival was not different across groups and was similar to that previously reported (35 months). Kaplan-Meier analysis did not show any difference in 5-year survival between both groups. CONCLUSIONS: In a clinical context in which the diagnosis of UIP can be obtained as a dynamic process that includes an integrated clinical, radiological and pathologic approach, a reliable diagnosis of UIP can be obtained based on a typical definite HRCT with no risk of including patients with a more benign disease and a more prolonged survival.