The effectiveness of mapping-targeted biopsies on the index lesion in transperineal prostate biopsies.

PURPOSE: To evaluate the effectiveness of mapping-targeted biopsies (MTB) on the index lesion for the detection of clinically significant prostate cancer (csPCa) in transperineal fusion-image prostate biopsies. MATERIALS AND METHODS: A retrospective analysis was conducted on 309 men with suspected PCa who underwent prostate biopsies at the Creu Blanca reference center in Barcelona, Spain. The Prostate Imaging-Reporting and Data System (PI-RADS v.2.1) of the magnetic resonance images (MRI) were reclassified by an expert radiologist reading of pre-biopsy biparametric MRI used for segmentation of suspected lesions. Transperineal MTB of suspicious lesions and 12-core systematic biopsies were performed using the Artemis™ platform. CsPCa was defined as International Society of Urological Pathology grade group ≥ 2. RESULTS: CsPCa was detected in 192 men (62.1%), with detection rates of 6.3% for PI-RADS 2, 26.8% for PI-RADS 3, 87.3% for PI-RADS 4, and 93.1% for PI-RADS 5. MTB of the index lesion identified 185 csPCa (96.3%). CsPCa was detected solely in systematic biopsies in three cases (1.6%), while an additional four cases (2.1%) were identified only in the second suspected lesion. A predictive model for csPCa detection in MTB of the index lesion was developed, with an AUC of 0.918 (95% CI 0.887-0.950). CONCLUSIONS: This model had the potential to avoid 23.3% of prostate biopsies without missing additional csPCa cases. MTB of the index lesion was highly effective for identifying csPCa in fusion transperineal prostate biopsies. A developed predictive model successfully reduced the need for almost one quarter of biopsies without missing csPCa cases.

Insight into response to mTOR inhibition when PKD1 and TSC2 are mutated.

BACKGROUND: Mutations in TSC1 or TSC2 cause the tuberous sclerosis complex (TSC), while mutations in PKD1 or PKD2 cause autosomal dominant polycystic kidney disease (ADPKD). PKD1 lays immediately adjacent to TSC2 and deletions involving both genes, the PKD1/TSC2 contiguous gene syndrome (CGS), are characterized by severe ADPKD, plus TSC. mTOR inhibitors have proven effective in reducing angiomyolipoma (AML) in TSC and total kidney volume in ADPKD but without a positive effect on renal function. METHODS AND RESULTS: We describe a patient with independent truncating PKD1 and TSC2 mutations who has the expected phenotype for both diseases independently instead of the severe one described in PKD1/TSC2-CGS. Treatment with mTOR inhibitors reduced the AML and kidney volume for 2 years but thereafter they resumed growth; no positive effect on renal function was seen throughout. This is the first case addressing the response to mTOR treatment when independent truncating mutations in PKD1 and TSC2 are present. CONCLUSIONS: This case reveals that although PKD1 and TSC2 are adjacent genes and there is likely cross-talk between the PKD1 and TSC2 signalling pathways regulating mTOR, having independent TSC2 and PKD1 mutations can give rise to a milder kidney phenotype than is typical in PKD1/TSC2-CGS cases. A short-term beneficial effect of mTOR inhibition on AML and total kidney volume was not reflected in improved renal function.

An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis: the renal artery contrast-free trial.

OBJECTIVE: The unenhanced MR angiography (MRA) technique time-spatial labeling inversion pulse (time-SLIP) may provide a safe alternative for evaluating the renal arteries for stenosis. This international multicenter trial tested the hypothesis that time-SLIP unenhanced MRA is accurate and robust for assessing the renal arteries for stenosis in comparison with contrast-enhanced CT angiography (CTA). SUBJECTS AND METHODS: Four centers (United States, Europe, Asia) enrolled 75 patients (average age ± SD, 58 ± 13 years; 41 [55%] men and 34 [45%] women). Each patient underwent abdominal contrast-enhanced CTA and abdominal unenhanced MRA using time-SLIP with balanced steady-state free precession. All images were visually assessed for quality (arterial signal intensity) and for the absence or presence of renal artery stenosis (≤ 50% or > 50% stenosis, respectively). In addition, for arteries with any visible disease, the severity of the stenosis was quantified. Two blinded readers evaluated each study. No arteries were excluded from analysis. RESULTS: Unenhanced MRA image quality was excellent for 56 of 75 patients (75%) and good for 16 of 75 patients (21%). CTA was used as the reference standard and showed that 23 of 161 renal arteries (14.3%) had stenosis > 50%. Unenhanced MRA correctly classified 17 of the 23 renal arteries with > 50% stenosis and correctly classified 128 of the 138 renal arteries as not having disease (≤ 50% stenosis) to yield a sensitivity of 74%, specificity of 93%, and accuracy of 90% (χ(2) = 0.56; p = 0.45, no statistically significant difference). Of the 16 misclassified arteries, only three had a clinically relevant misclassification (CTA ≥ 70% stenosis and unenhanced MRA ≤ 50% stenosis or unenhanced MRA ≥ 70% stenosis and CTA ≤ 50% stenosis). On average, measured stenotic severity (n = 28 arteries) was similar for unenhanced MRA (64% ± 17%) and CTA (62% ± 16%) (p = 0.51). CONCLUSION: Compared with contrast-enhanced CTA, the unenhanced MRA technique time-SLIP shows promise for assessing the renal arteries for stenosis. The unenhanced MRA technique time-SLIP may provide a safe alternative for evaluating the renal arteries for stenosis.

A Systematic Review of the Current Status of Magnetic Resonance-Ultrasound Images Fusion Software Platforms for Transperineal Prostate Biopsies.

Given this new context, our objective is to recognize the suitability of the currently available software for image fusion and the reported series using the transperineal route, as well as to generate new evidence on the complementarity of the directed and systematic biopsies, which has been established through the transrectal approach. EVIDENCE ACQUISITION: This systematic review, registered in Prospero (CRD42022375619), began with a bibliographic search that was carried out in PubMed, Cochrane, and Google Scholar databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria and the studied eligibility based on the Participants, Intervention, Comparator, and Outcomes (PICO) strategy were followed. Warp analysis of selected studies was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. In addition, a Google search of all currently available fusion platforms was performed. Our Google search found 11 different commercially available robots to perform transperineal image fusion biopsies, of which 10 devices have published articles supporting their diagnostic effectiveness in transperineal prostate biopsies. RESULTS: A total of 30 articles were selected and the characteristics and results of the biopsies of 11,313 patients were analyzed. The pooled mean age was 66.5 years (63-69). The mean pooled PSA level was 7.8 ng/mL (5.7-10.8). The mean pooled prostate volume was 45.4 cc. (34-56). The mean pooled PSA density was 0.17 (0.12-0.27). The overall cancer detection rate for all prostate cancers was 61.4%, while for csPCa it was 47.8%. PCa detection rate was more effective than that demonstrated in the systematic transrectal biopsy. However, the detection of csPCa in the systematic biopsy was only 9.5% in the reported series. To standardize our review, we grouped prostate cancer screening results according to the population studied and the software used. When the same populations were compared between elastic and rigid software, we found that rigid biopsies had a higher csPCa detection rate than biopsies with elastic fusion systems. CONCLUSION: Platforms performing prostate biopsy using transperineal image fusion have better detection rates of csPCa than systematic transrectal biopsies. Rigid fusion systems have a better csPCa detection rate than elastic ones. We found no diagnostic differences between the different types of robotic systems currently available. The complementarity of systematic biopsy has also been demonstrated in transperineal imaging fusion biopsies.

International Multi-Site Initiative to Develop an MRI-Inclusive Nomogram for Side-Specific Prediction of Extraprostatic Extension of Prostate Cancer.

BACKGROUND: To develop an international, multi-site nomogram for side-specific prediction of extraprostatic extension (EPE) of prostate cancer based on clinical, biopsy, and magnetic resonance imaging- (MRI) derived data. METHODS: Ten institutions from the USA and Europe contributed clinical and side-specific biopsy and MRI variables of consecutive patients who underwent prostatectomy. A logistic regression model was used to develop a nomogram for predicting side-specific EPE on prostatectomy specimens. The performance of the statistical model was evaluated by bootstrap resampling and cross validation and compared with the performance of benchmark models that do not incorporate MRI findings. RESULTS: Data from 840 patients were analyzed; pathologic EPE was found in 320/840 (31.8%). The nomogram model included patient age, prostate-specific antigen density, side-specific biopsy data (i.e., Gleason grade group, percent positive cores, tumor extent), and side-specific MRI features (i.e., presence of a PI-RADSv2 4 or 5 lesion, level of suspicion for EPE, length of capsular contact). The area under the receiver operating characteristic curve of the new, MRI-inclusive model (0.828, 95% confidence limits: 0.805, 0.852) was significantly higher than that of any of the benchmark models (p < 0.001 for all). CONCLUSIONS: In an international, multi-site study, we developed an MRI-inclusive nomogram for the side-specific prediction of EPE of prostate cancer that demonstrated significantly greater accuracy than clinical benchmark models.

Use of multidetector CT in presurgical evaluation of potential kidney transplant recipients.

Kidney transplantation is the treatment of choice for end-stage renal disease. Optimal presurgical evaluation of the potential kidney transplant recipient is important for the success of the transplantation. Multidetector computed tomography (CT) allows assessment of the feasibility of kidney transplantation; detection of coexisting illnesses that may affect survival of the graft and that must be treated before transplantation; and evaluation of possible peripheral vascular disease, which is present in a significant number of potential kidney transplant recipients. Multidetector CT provides a wide range of information in these patients. Vascular and extravascular systems can be evaluated, allowing one to determine whether kidney transplantation is possible, whether presurgical procedures are necessary, and which is the best surgical technique for each candidate. Knowledge of the surgical techniques, use of an optimal multidetector CT technique, and the ability to identify common and uncommon radiologic findings are essential for correct evaluation of potential kidney transplant recipients.

CT findings in urinary diversion after radical cystectomy: postsurgical anatomy and complications.

Numerous surgical procedures have been developed for urinary diversion in patients who have undergone a radical cystectomy for bladder cancer or, less frequently, a benign condition. Because urinary diversion procedures are complex, early and late postsurgical complications frequently occur. Possible complications include alterations in bowel motility, anastomotic leaks, fluid collections (abscess, urinoma, lymphocele, and hematoma), fistulas, peristomal herniation, ureteral strictures, calculi, and tumor recurrence. Computed tomography (CT) is an accurate method for evaluating such events. Multiplanar reformatting and three-dimensional volume rendering of multidetector CT image data are particularly useful for achieving an accurate and prompt diagnosis of complications and obtaining information that is essential for adequate surgical management. In addition, knowledge of urinary diversion procedures, normal postsurgical appearances, and optimal CT technique for postsurgical evaluations is essential for detecting complications and avoiding misdiagnosis.

The effectiveness of mapping-targeted biopsies on the index lesion in transperineal prostate biopsies

ABSTRACT Purpose: To evaluate the effectiveness of mapping-targeted biopsies (MTB) on the index lesion for the detection of clinically significant prostate cancer (csPCa) in transperineal fusion-image prostate biopsies. Materials and Methods: A retrospective analysis was conducted on 309 men with suspected PCa who underwent prostate biopsies at the Creu Blanca reference center in Barcelona, Spain. The Prostate Imaging-Reporting and Data System (PI-RADS v.2.1) of the magnetic resonance images (MRI) were reclassified by an expert radiologist reading of pre-biopsy biparametric MRI used for segmentation of suspected lesions. Transperineal MTB of suspicious lesions and 12-core systematic biopsies were performed using the Artemis™ platform. CsPCa was defined as International Society of Urological Pathology grade group ≥ 2. Results: CsPCa was detected in 192 men (62.1%), with detection rates of 6.3% for PI-RADS 2, 26.8% for PI-RADS 3, 87.3% for PI-RADS 4, and 93.1% for PI-RADS 5. MTB of the index lesion identified 185 csPCa (96.3%). CsPCa was detected solely in systematic biopsies in three cases (1.6%), while an additional four cases (2.1%) were identified only in the second suspected lesion. A predictive model for csPCa detection in MTB of the index lesion was developed, with an AUC of 0.918 (95% CI 0.887-0.950). Conclusions: This model had the potential to avoid 23.3% of prostate biopsies without missing additional csPCa cases. MTB of the index lesion was highly effective for identifying csPCa in fusion transperineal prostate biopsies. A developed predictive model successfully reduced the need for almost one quarter of biopsies without missing csPCa cases.

Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know.

External beam radiotherapy (EBRT) is one of the principal curative treatments for patients with prostate cancer (PCa). Risk group classification is based on prostate-specific antigen (PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging (MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI (mpMRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrast-enhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpMRI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decision-making for EBRT. mpMRI is also being used in salvage radiotherapy (SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence - pelvic (local, nodal, or bone) or distant - in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpMRI in detecting local recurrences - even in patients with low PSA levels (0.3-0.5 ng/mL) - and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpMRI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.

Assessing the effectiveness of rapamycin on angiomyolipoma in tuberous sclerosis: a two years trial.

BACKGROUND: Tuberous sclerosis (TS) is a rare autosomal dominant systemic disease with an estimated prevalence of 1/6000. Renal angiomyolipoma (AML) is a benign tumour with high morbidity frequently present in TS. The aim of the study was to test the effect of rapamycin in reducing the volume of AML in TS. METHODS: Twenty four-month prospective open-label, single arm, unicentre Phases II andIII study. The primary endpoint was to evaluate the effect of treatment on the reduction of at least 50% AML volume from baseline at 24 months. The secondary endpoints were: average tumour reduction, surgical complications, skin lesions and drug safety.The study population comprised 17 patients, aged >10 years who were diagnosed with TS and had ≥1 renal AML >2 cm of diameter and had a serum creatinine < 2mg/dl and urine protein/creatinine ratio < 22.6 mg/mmol. The trial was conducted at Fundació Puigvert. Rapamycin was given to achieve stable plasma levels between 4 and 8 ng/ml. AML volume was estimated using orthogonal measurements by MRI at baseline, 6, 12 and 24 months. RESULTS: Ten out of 17 patients were success responders for the main outcome -58.8%, 95%CI: 32.9% to 81.6%-. After 6 months of therapy, the mean volume decrease was 55.18% (5.01 standard error (SE); p<0.001) and 66.38% (4.41 SE; p<0.001) at year 1. There was no significant decrease between year 1 and 2. According to RECIST criteria, all patients achieved a partial response at year 1 and all but two had already achieved this partial response after 6 months.The main analysis was performed according to the intention-to-treat principle analysis. Tumour volume was analyzed over time by means of mixed models for repeated measurement analysis. We used the baseline tumour volume as a covariate for the absolute change and percentage change from baseline data. The analysis was performed using SAS version 9.2 software, and the level of significance was established at 0.05 (two-sided). CONCLUSIONS: This study show that mTOR inhibitors are a relatively safe, efficacious and less aggressive alternative than currently available options in the management of AML in TS. TRIAL REGISTRATION: EudraCT number: 2007-005978-30, ClinicalTrials.gov number: NCT0121712.

Effects of rapamycin on angiomyolipomas in patients with tuberous sclerosis.

BACKGROUND: Tuberous sclerosis (TS) is a systemic disease, with an autosomal dominant pattern of inheritance caused by mutations in two genes (TSC1 and TSC2) that cause tumours (angiomyolipomas [AML], angiofibromas, astrocytomas). Constant and inadequate proliferation occurring in TS may be blocked by mTOR inhibitors (mammalian target of rapamycin), such as rapamycin. MATERIAL AND METHODS: At present, our study includes 17 patients with TS. All had at least one AML greater than 2cm in diameter diagnosed by MRI. They received rapamycin during 12 months. Plasma levels remained stable between 4-8ng/dl. The AML size was monitored every six months by abdominal MRI. RESULTS: At 12 months of inclusion, MRI indicated a decrease in the size of AML in all patients showing at least a 50% reduction in 82.4% (14/17, 95% CI [56.57%, 96.20%]). The mean percent reduction was 66.3% (95% CI [56.9%, 75.6%], P<.0001). The major side effects observed were: oral aphthous ulcers (5/17); hypertriglyceridemia (3/17); microcytosis and hypochromia (3/17); diarrhea (2/17); acne (1/17); acute pyelonephritis (1/17); and proteinuria (1/17). CONCLUSIONS: These preliminary clinical data suggest that rapamycin can play a beneficial role in the treatment of TS. Our experience in 17 patients treated for 12 months demonstrates safety and efficacy in reducing AML volume.

Importance of evaluating all vascular phases on contrast-enhanced sonography in the differentiation of benign from malignant focal liver lesions.

OBJECTIVE: Our objective was to evaluate the accuracy of a blood-pool sonographic contrast agent in the late phase compared with the three vascular phases for differentiation between benign and malignant focal liver lesions. SUBJECTS AND METHODS: In 152 patients (105 with chronic liver disease), 152 solid focal liver lesions characterized either by fine-needle biopsy or by dynamic CT or MRI were studied. The final diagnoses were metastasis for 24, hepatocellular carcinoma for 75, focal nodular hyperplasia for 13, regenerating or dysplastic nodule for 14, hemangioma for 22, cholangiocarcinoma for two, and another focal liver lesion for two. Real-time sonography was performed after a bolus injection of 2.4 mL of SonoVue, using a low mechanical index (< 0.2). All lesions were evaluated in the arterial, portal, and late phases; classified as benign or malignant; and correlated with final diagnoses. RESULTS: For discrimination between malignant and benign focal liver lesions, evaluation of all vascular phases improved the sensitivity from 78.4% to 98% and the accuracy from 80.9% to 92.7%, compared with evaluation of the late phase alone. The increase in accuracy was higher in patients with chronic liver disease (16.3%) than in those without (2.1%). CONCLUSION: Evaluation of SonoVue enhancement in all three vascular phases is superior to evaluation of SonoVue enhancement in the late phase alone, especially in patients with chronic liver disease.

Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiation.

The appearance of hepatocellular carcinoma (HCC) with contrast-enhanced ultrasound (CEUS) in the vascular phase is described and evaluated as to whether the enhancement pattern correlates with the degree of cellular differentiation. One hundred four HCCs were prospectively evaluated with CEUS using coherent-contrast imaging (CCI) and SonoVue with a low mechanical index (<0.2). The enhancement of HCCs in the vascular phase was analyzed according to the degree of pathological differentiation obtained by fine-needle biopsy. In the arterial phase, all HCCs except for four well differentiated ones (96.2%) showed enhancement ( P<0.05). Histological differentiation of hypoechoic lesions in the early portal phase (7 HCCs; 16%) significantly differed from hyperechoic (1 HCC; 1%) or isoechoic lesions (87 HCCs; 83.6%) ( P<0.05), with a significant probability of a worse differentiation in hypoechoic lesions. Histological differentiation of isoechoic lesions in the late phase (30 HCCs; 28.8%) significantly differed from hypoechoic lesions (74 HCCs; 71.2%) ( P<0.05), with a significant probability of a better differentiation in isoechoic lesions. CEUS using CCI and SonoVue revealed enhancement in the arterial phase in >95% of HCCs, with a few well-differentiated cases not being diagnosed due to the absence of enhancement. Echogenicity in the portal and late phases correlated with cellular differentiation.

Armónica-inversión de pulsos y agente de contraste US: caracterización de lesiones focales hepáticas / Pulse inversion harmonic US imaging after levovist injection: patterns in hepatic focal lesions

Propósito: Evaluar con armónica-inversión de pulsos (AIP) y agente de contraste ultrasonográfico el realce a nivel de la microcirculación hepática y establecer diferencias en el comportamiento de lesiones focales sólidas (LFS). Material y Métodos: Se incluyeron 31 pacientes con 37 LFS: 13/37 hepatocarcinomas (HC), 14/37 hemangiomas (HG) y 10/37 metástasis (MTS). El diagnóstico de MTS y de HC se definió histológicamente y el de HG con TC o RNM y seguimiento. Ecorrealzador: Se utilizó Levovist, inyectándose en bolo rápido 12 ml de solución (400 mgs/ml). Técnica US: Se utilizó un equipo ATL HDI 5000 con transductor convex 2-5 Mhz. Procedimiento: 1. Se configuró para evaluación con AIP y alto índice mecánico (1,3). 2. Se obtuvo un registro basal. 3. Se administró el ecorrealzador. 4. Transcurridos 30 se barrió la lesión. El procedimiento se repitió cada 30, durante 5, guardándose en cine-loops para su evaluación ulterior con un programa de investigación (HDI LAB; ATL Ultrasound). Análisis cualitativo: se definió el realce parenquimatoso como presente o ausente. El realce lesional se agrupó en: ausente (AU), periférico globular (PG), periférico anular (PA), intralesional (IL). Análisis cuantitativo: se cuantificó en dB el realce lesional y el parenquimatoso. Análisis estadístico: se utilizó media ñ DS y X2. Resultados: Análisis cualitativo: Realce parenquimatoso presente en todos los casos. Realce lesional AU: 0/13 HC, 8/14 HG y 5/10 MTS (p<0.05). Realce PG: 6/14 HG y en ningún HC ni MTS (p<0.05). Realce PA: 5/10 MTS y en ningún HC ni HG (p<0.05). Realce IL: 13/13 HC y en ningún HG ni MTS (p<0.05). Análisis cuantitativo: La media de la intensidad del realce fue: parénquima hepático, 17 ñ 4 dB; HC, 25 ñ 7 dB; HG con realce PG, 23 ñ 5 dB; MTS con realce PA de 20 ñ 3 dB; lesiones con realce AU 4 ñ 3 dB. Conclusiones: utilizando AIP y ecorrealzador es posible lograr realce a nivel de la microcirculación hepática. Las LFS mostraron diferencias en su comportamiento, sugeriendo que éste procedimiento puede ser de utilidad en su caracterización

Armónica-inversión de pulsos y agente de contraste US: caracterización de lesiones focales hepáticas / Pulse inversion harmonic US imaging after levovist injection: patterns in hepatic focal lesions

Propósito: Evaluar con armónica-inversión de pulsos (AIP) y agente de contraste ultrasonográfico el realce a nivel de la microcirculación hepática y establecer diferencias en el comportamiento de lesiones focales sólidas (LFS). Material y Métodos: Se incluyeron 31 pacientes con 37 LFS: 13/37 hepatocarcinomas (HC), 14/37 hemangiomas (HG) y 10/37 metástasis (MTS). El diagnóstico de MTS y de HC se definió histológicamente y el de HG con TC o RNM y seguimiento. Ecorrealzador: Se utilizó Levovist, inyectándose en bolo rápido 12 ml de solución (400 mgs/ml). Técnica US: Se utilizó un equipo ATL HDI 5000 con transductor convex 2-5 Mhz. Procedimiento: 1. Se configuró para evaluación con AIP y alto índice mecánico (1,3). 2. Se obtuvo un registro basal. 3. Se administró el ecorrealzador. 4. Transcurridos 30 se barrió la lesión. El procedimiento se repitió cada 30, durante 5, guardándose en cine-loops para su evaluación ulterior con un programa de investigación (HDI LAB; ATL Ultrasound). Análisis cualitativo: se definió el realce parenquimatoso como presente o ausente. El realce lesional se agrupó en: ausente (AU), periférico globular (PG), periférico anular (PA), intralesional (IL). Análisis cuantitativo: se cuantificó en dB el realce lesional y el parenquimatoso. Análisis estadístico: se utilizó media ñ DS y X2. Resultados: Análisis cualitativo: Realce parenquimatoso presente en todos los casos. Realce lesional AU: 0/13 HC, 8/14 HG y 5/10 MTS (p<0.05). Realce PG: 6/14 HG y en ningún HC ni MTS (p<0.05). Realce PA: 5/10 MTS y en ningún HC ni HG (p<0.05). Realce IL: 13/13 HC y en ningún HG ni MTS (p<0.05). Análisis cuantitativo: La media de la intensidad del realce fue: parénquima hepático, 17 ñ 4 dB; HC, 25 ñ 7 dB; HG con realce PG, 23 ñ 5 dB; MTS con realce PA de 20 ñ 3 dB; lesiones con realce AU 4 ñ 3 dB. Conclusiones: utilizando AIP y ecorrealzador es posible lograr realce a nivel de la microcirculación hepática. Las LFS mostraron diferencias en su comportamiento, sugeriendo que éste procedimiento puede ser de utilidad en su caracterización (AU)

Biopsia percutánea de pulmón con aguja gruesa: análisis de las complicaciones / Complications after CT guided large-needle biopsy of the lung

La biopsia percutánea de pulmón es de uso corriente para el diagnóstico anatomopatológico de nódulos pulmonares y en la patología difusa de este órgano, utilizando agujas finas y gruesas. Las complicaciones derivadas del procedimiento son: el neumotórax y el sangrado del parénquima pulmonar. Realizamos prospectivamente 59 biopsias de nódulos pulmonares con aguja gruesa con un único intento (pase), guiadas por TC. La intención en todos los casos fue obtener tejido diagnóstico con mínimas complicaciones. La obtención del material histológico en un único intento puede lograrse con riesgo similar al de varios pases con aguja fina. Como ventaja adicional hemos considerado la mayor disponibilidad y el menor costo de las agujas espinales. El neumotórax se observó en el 23,72 por ciento de los pacientes y el sangrado del parénquima pulmonar en el 20,34 por ciento. Existe una gran dispersión bibliográfica acerca de la frecuencia del neumotórax como complicación de la punción percutánea pulmonar (10 al 60 por ciento). Por lo cual el resultado de 23,72 por ciento parece aceptable, lo mismo con respecto a la obtención de material diagnóstico (75 por ciento). El sangrado del parénquima pulmonar cuando ocurrió no tuvo mayor significación clínica

Biopsia percutánea de pulmón con aguja gruesa: análisis de las complicaciones / Complications after CT guided large-needle biopsy of the lung

La biopsia percutánea de pulmón es de uso corriente para el diagnóstico anatomopatológico de nódulos pulmonares y en la patología difusa de este órgano, utilizando agujas finas y gruesas. Las complicaciones derivadas del procedimiento son: el neumotórax y el sangrado del parénquima pulmonar. Realizamos prospectivamente 59 biopsias de nódulos pulmonares con aguja gruesa con un único intento (pase), guiadas por TC. La intención en todos los casos fue obtener tejido diagnóstico con mínimas complicaciones. La obtención del material histológico en un único intento puede lograrse con riesgo similar al de varios pases con aguja fina. Como ventaja adicional hemos considerado la mayor disponibilidad y el menor costo de las agujas espinales. El neumotórax se observó en el 23,72 por ciento de los pacientes y el sangrado del parénquima pulmonar en el 20,34 por ciento. Existe una gran dispersión bibliográfica acerca de la frecuencia del neumotórax como complicación de la punción percutánea pulmonar (10 al 60 por ciento). Por lo cual el resultado de 23,72 por ciento parece aceptable, lo mismo con respecto a la obtención de material diagnóstico (75 por ciento). El sangrado del parénquima pulmonar cuando ocurrió no tuvo mayor significación clínica (AU)