[Value of contrast-enhanced ultrasound in the diagnosis of hepatocarcinoma in focal lesions detected in patients with liver disease]. / Valor de los contrastes ecográficos en el diagnóstico de hepatocarcinoma en lesiones ocupantes de espacio detectadas en pacientes con hepatopatía.

OBJECTIVE: To assess the value of contrast-enhanced ultrasound in the detection of arterial hypervascularity as a diagnostic criterion of hepatocellular carcinoma (HCC) in patients with focal lesions and liver disease. PATIENTS AND METHODS: This prospective study included patients with chronic liver disease and focal liver lesions on ultrasound (US) examination. SonoVue was used as contrast agent. We employed a US imaging technique with contrast-specific software operating at a low mechanical index (< 0.14) (Hitachi EUB 6500). The contrast enhancement pattern was analyzed during the arterial phase and classified as diffuse (homogeneous or heterogeneous), peripheral, adjacent parenchyma-like enhancement, and absent. The diagnostic procedure was completed by combined study with computed tomography, magnetic resonance imaging, histologic data and clinical features. RESULTS: A total of 23 nodules in 22 patients were included in the study (one patient had two different US lesions). The final diagnosis was hepatocellular carcinoma (HCC) in 12 patients, benign lesions in nine, metastases in one and cholangiocarcinoma in one. In the 10 patients with diffuse contrast enhancement, the lesion was malignant and in the eight patients with diffuse homogeneous enhancement, the lesion was a HCC. Seventy-five percent of the patients with HCC had a diffuse enhancement pattern during the arterial phase. This pattern involved malignancy with 71.4% sensitivity, 100% specificity, 100% positive predictive value, 69.2% negative predictive value, and 82.6% accuracy. The diffuse homogeneous pattern involved HCC with 66.7% sensitivity, 100% specificity, 100% positive predictive value, 73.3% negative predictive value and 82.6% accuracy. CONCLUSIONS: Contrast-enhanced US with SonoVue allows the vascularity of focal liver lesions to be assessed. In our study, 75% of patients with HCC showed arterial hypervascularity. A diffuse homogeneous enhancement pattern during the arterial phase was highly specific to HCC. In cirrhotic patients, this arterial pattern could avoid the need for further investigations, although clinical staging should be completed with another diagnostic test.

Valor de los contrastes ecográficos en el diagnóstico de hepatocarcinoma en lesiones ocupantes de espacio detectadas en pacientes con hepatopatía / Value of contrast-enhanced ultrasound in the diagnosis of hepatocarcinoma in focal lesions detected in patients with liver disease

Objetivo: Determinar la utilidad de la ecografía con contraste en la detección de hipervascularización arterial como criterio diagnóstico de carcinoma hepatocelular (CHC) en lesiones ocupantes de espacio (LOE) de pacientes con hepatopatía. Pacientes y métodos: Estudio prospectivo en el que se incluyen pacientes con hepatopatía crónica a los que se detectó alguna LOE mediante ecografía. Como potenciador se administró un contraste de segunda generación (SonoVue®). Se utilizó un ecógrafo Hitachi EUB 6500 con un programa específico para potenciadores, y se empleó un índice mecánico inferior a 0,14. Se analizó el patrón de captación en fase arterial, clasificándose en patrón difuso (homogéneo o heterogéneo), periférico, captación similar al parénquima circundante y ausencia de captación. El diagnóstico definitivo se confirmó mediante el estudio combinado de tomografía computarizada, resonancia magnética y análisis histológico, junto con la evolución clínica. Resultados: Se incluyen 23 lesiones en 22 pacientes (uno presentó 2 lesiones de características ecográficas diferentes). El diagnóstico final fue: CHC en 12 casos, lesiones benignas en 9, metástasis en uno y colangiocarcinoma en otro caso. Todos los casos que presentaron un patrón difuso con el contraste tenían una lesión maligna, y los 8 casos con patrón difuso homogéneo tenían un CHC. El 75% de los pacientes con CHC presentó una hipervascularización arterial con un patrón difuso tras el contraste. Este patrón difuso presentó una sensibilidad del 71,4%, especificidad del 100%, valor predictivo positivo (VPP) del 100%, valor predictivo negativo (VPN) del 69,2% y exactitud del 82,6% para el diagnóstico de malignidad. El patrón difuso homogéneo presentó una sensibilidad del 66,7%, una especificidad del 100%, un VPP del 100%, un VPN del 73,3% y una exactitud del 82,6% para el diagnóstico de CHC. Conclusiones: La utilización de la ecografía con contraste de segunda generación facilita una caracterización vascular inmediata de la lesión. En nuestro estudio se detecta una hipervascularización arterial en el 75% de los pacientes con CHC. Un patrón de realce difuso homogéneo es muy específico de CHC. Creemos que la detección de este tipo de patrón en un paciente con cirrosis haría innecesaria la utilización de más pruebas de imagen para el diagnóstico, si bien el estudio de extensión debe completarse con otra técnica

Objective: To assess the value of contrast-enhanced ultrasound in the detection of arterial hypervascularity as a diagnostic criterion of hepatocellular carcinoma (HCC) in patients with focal lesions and liver disease. Patients and methods: This prospective study included patients with chronic liver disease and focal liver lesions on ultrasound (US) examination. SonoVue® was used as contrast agent. We employed a US imaging technique with contrast-specific software operating at a low mechanical index (< 0.14) (Hitachi EUB 6500). The contrast enhancement pattern was analyzed during the arterial phase and classified as diffuse (homogeneous or heterogeneous), peripheral, adjacent parenchyma-like enhancement, and absent. The diagnostic procedure was completed by combined study with computed tomography, magnetic resonance imaging, histologic data and clinical features. Results: A total of 23 nodules in 22 patients were included in the study (one patient had two different US lesions). The final diagnosis was hepatocellular carcinoma (HCC) in 12 patients, benign lesions in nine, metastases in one and cholangiocarcinoma in one. In the 10 patients with diffuse contrast enhancement, the lesion was malignant and in the eight patients with diffuse homogeneous enhancement, the lesion was a HCC. Seventy-five percent of the patients with HCC had a diffuse enhancement pattern during the arterial phase. This pattern involved malignancy with 71.4% sensitivity, 100% specificity, 100% positive predictive value, 69.2% negative predictive value, and 82.6% accuracy. The diffuse homogeneous pattern involved HCC with 66.7% sensitivity, 100% specificity, 100% positive predictive value, 73.3% negative predictive value and 82.6% accuracy. Conclusions: Contrast-enhanced US with SonoVue® allows the vascularity of focal liver lesions to be assessed. In our study, 75% of patients with HCC showed arterial hypervascularity. A diffuse homogeneous enhancement pattern during the arterial phase was highly specific to HCC. In cirrhotic patients, this arterial pattern could avoid the need for further investigations, although clinical staging should be completed with another diagnostic test

[Clinicopathological characteristics of uninvestigated dyspepsia in Spain]. / Características clinicopatológicas de la dispepsia no investigada en España.

INTRODUCTION: Most patients with uninvestigated dyspepsia are diagnosed with functional dyspepsia. Various types of Helicobacter pylori gastritis have been described, each of which is associated with a distinct natural history of the infection (i.e. a different risk of ulcer or gastric cancer). OBJECTIVE: To determine the clinical and pathological characteristics of patients with uninvestigated dyspepsia in our area and the prevalence of the distinct types of H. pylori gastritis among patients with functional dyspepsia. MATERIAL AND METHODS: Ninety-eight patients (47 men and 51 women, mean age 35.8+/-13 years) with uninvestigated dyspepsia were included in this study. All the patients completed the Dyspepsia-Related Health Scale and all patients underwent gastroscopy with biopsy and the C13-urea breath test. RESULTS: Fourteen patients had organic causes of dyspepsia and 78 had functional dyspepsia. Fifty-one patients with functional dyspepsia (65%) had H. pylori infection; of these, 27 had pangastritis, 21 had antrum-predominant gastritis, 2 had multifocal atrophic gastritis and 1 had normal gastric mucosa. Among uninfected patients, 2 had multifocal atrophic gastritis. CONCLUSIONS: The prevalence of functional dyspepsia in this series was 85%. Twenty-seven percent of patients with functional dyspepsia had a combination of H. pylori infection and antrum-predominant gastritis, the type of gastritis predisposing to duodenal ulcer. Only 5% of the patients had multifocal atrophic gastritis, which is associated with a high risk of gastric cancer.

Características clinicopatológicas de la dispepsia no investigada en España / Clinicopathological characteristics of uninvestigated dyspepsia in Spain

Introducción: La mayoría de los pacientes con dispepsia no investigada son diagnosticados de dispepsia funcional. Se han descrito varios tipos de gastritis por Helicobacter pylori, cada uno de los cuales se asocia a una historia natural diferente de la infección (p. ej., diferente riesgo de enfermedad ulcerosa o de cáncer gástrico). Objetivo: Determinar las características clínicas y patológicas de los pacientes con dispepsia no investigada en nuestra área y la prevalencia de los diferentes tipos de gastritis por H. pylori en los pacientes con dispepsia funcional. Material y métodos: Se incluyó en el estudio a 98 pacientes (47 varones y 51 mujeres, con una media de edad de 35,8 ± 13 años) con dispepsia no investigada. Todos ellos rellenaron el Cuestionario de Calidad de Vida Asociada a Dispepsia, y a todos se les realizó gastroscopia con toma de biopsias y test del aliento con C13-Urea. Resultados: Catorce pacientes tenían causas orgánicas de dispepsia y 78 dispepsia funcional; 51 pacientes con dispepsia funcional (65%) tenían infección por H. pylori y, de ellos, 27 tenía pangastritis, 21 gastritis de predominio antral, 2 gastritis atrófica multifocal y 1 mucosa gástrica normal. Entre los pacientes no infectados, 2 presentaban gastritis atrófica multifocal. Conclusiones: La prevalencia de dispepsia funcional en esta serie fue del 85%. Un 27% de los pacientes con dispepsia funcional presenta la combinación de infección por H. pylori y gastritis de predominio antral, que es el tipo de gastritis que predispone a la aparición de enfermedad ulcerosa duodenal. Sólo un 5% de los pacientes tiene gastritis atrófica multifocal, que es la que se asocia con un riesgo elevado de cáncer gástrico

Introduction: Most patients with uninvestigated dyspepsia are diagnosed with functional dyspepsia. Various types of Helicobacter pylori gastritis have been described, each of which is associated with a distinct natural history of the infection (i.e. a different risk of ulcer or gastric cancer). Objective: To determine the clinical and pathological characteristics of patients with uninvestigated dyspepsia in our area and the prevalence of the distinct types of H. pylori gastritis among patients with functional dyspepsia. Material and methods: Ninety-eigth patients (47 men and 51 women, mean age 35.8 ± 13 years) with uninvestigated dyspepsia were included in this study. All the patients completed the Dyspepsia-Related Health Scale and all patients underwent gastroscopy with biopsy and the C13-urea breath test. Results: Fourteen patients had organic causes of dyspepsia and 78 had functional dyspepsia. Fifty-one patients with functional dyspepsia (65%) had H. pylori infection; of these, 27 had pangastritis, 21 had antrum-predominant gastritis, 2 had multifocal atrophic gastritis and 1 had normal gastric mucosa. Among uninfected patients, 2 had multifocal atrophic gastritis. Conclusions: The prevalence of functional dyspepsia in this series was 85%. Twenty-seven percent of patients with functional dyspepsia had a combination of H. pylori infection and antrum-predominant gastritis, the type of gastritis predisposing to duodenal ulcer. Only 5% of the patients had multifocal atrophic gastritis, which is associated with a high risk of gastric cancer