In vivocharacterization of the optical and hemodynamic properties of the human sternocleidomastoid muscle through ultrasound-guided hybrid near-infrared spectroscopies.

Objective.In this paper, we present a detailedin vivocharacterization of the optical and hemodynamic properties of the human sternocleidomastoid muscle (SCM), obtained through ultrasound-guided near-infrared time-domain and diffuse correlation spectroscopies.Approach.A total of sixty-five subjects (forty-nine females, sixteen males) among healthy volunteers and thyroid nodule patients have been recruited for the study. Their SCM hemodynamic (oxy-, deoxy- and total hemoglobin concentrations, blood flow, blood oxygen saturation and metabolic rate of oxygen extraction) and optical properties (wavelength dependent absorption and reduced scattering coefficients) have been measured by the use of a novel hybrid device combining in a single unit time-domain near-infrared spectroscopy, diffuse correlation spectroscopy and simultaneous ultrasound imaging.Main results.We provide detailed tables of the results related to SCM baseline (i.e. muscle at rest) properties, and reveal significant differences on the measured parameters due to variables such as side of the neck, sex, age, body mass index, depth and thickness of the muscle, allowing future clinical studies to take into account such dependencies.Significance.The non-invasive monitoring of the hemodynamics and metabolism of the sternocleidomastoid muscle during respiration became a topic of increased interest partially due to the increased use of mechanical ventilation during the COVID-19 pandemic. Near-infrared diffuse optical spectroscopies were proposed as potential practical monitors of increased recruitment of SCM during respiratory distress. They can provide clinically relevant information on the degree of the patient's respiratory effort that is needed to maintain an optimal minute ventilation, with potential clinical application ranging from evaluating chronic pulmonary diseases to more acute settings, such as acute respiratory failure, or to determine the readiness to wean from invasive mechanical ventilation.

Glucocorticoid-induced Fingerprints on Visceral Adipose Tissue Transcriptome and Epigenome.

CONTEXT: Chronic glucocorticoid (GC) overexposure, resulting from endogenous Cushing's syndrome (CS) or exogenous GC therapy, causes several adverse outcomes, including persistent central fat accumulation associated with a low-grade inflammation. However, no previous multiomics studies in visceral adipose tissue (VAT) from patients exposed to high levels of unsuppressed GC during active CS or after remission are available yet. OBJECTIVE: To determine the persistent VAT transcriptomic alterations and epigenetic fingerprints induced by chronic hypercortisolism. METHODS: We employed a translational approach combining high-throughput data on endogenous CS patients and a reversible CS mouse model. We performed RNA sequencing and chromatin immunoprecipitation sequencing on histone modifications (H3K4me3, H3K27ac, and H3K27me3) to identify persistent transcriptional and epigenetic signatures in VAT produced during active CS and maintained after remission. RESULTS: VAT dysfunction was associated with low-grade proinflammatory status, macrophage infiltration, and extracellular matrix remodeling. Most notably, chronic hypercortisolism caused a persistent circadian rhythm disruption in VAT through core clock genes modulation. Importantly, changes in the levels of 2 histone modifications associated to gene transcriptional activation (H3K4me3 and H3K27ac) correlated with the observed differences in gene expression during active CS and after CS remission. CONCLUSION: We identified for the first time the persistent transcriptional and epigenetic signatures induced by hypercortisolism in VAT, providing a novel integrated view of molecular components driving the long-term VAT impairment associated with CS.

Long-Term Follow-Up of Single-Fiber Multiple Low-Intensity Energy Laser Ablation Technique of Benign Thyroid Nodules.

AIM: The short-term and long-term efficacy of different thermal percutaneous ablation techniques remains a topical issue. Our group implemented percutaneous laser ablation (LA), a moving-shot technique to increase efficiency and reduce costs and variability of LA by applying multiple lower-intensity energy illuminations (MLIEI) covering the nodular volume (V) through changes in position of a single laser fiber within the thyroid nodule. The aim of the present study was to evaluate the efficacy of the single-fiber LA-MLIEI during a 5-year follow-up and to identify possible predictors of the final outcome. METHODS: Prospective study: Thirty outpatients (23 women and seven men) with benign symptomatic thyroid nodules were assigned to single-fiber LA-MLIEI, between 2012 and 2015. A single LA session was performed under real-time ultrasound (US) guidance using a 1,064-nm continuous-wave laser at 3 W. A 400-µm optical fiber was inserted through a 21-gauge needle, and 3-10 illuminations were performed per nodule, administering between 400 and 850 J/illumination. The total administered energy was calculated on the initial V of the nodule and the estimated ablation area. US evaluation was performed after LA-MLIEI at 1 week and 1, 3, 6, and 12 months and after that annually up to 5 years. Clinical symptoms, laboratory thyroid function during follow-up, and acute and chronic complications of treatment were registered. RESULTS: On follow-up, 67% (n: 20) were responders to single-fiber LA-MLIEI, while 33% (n: 10) were non-responders. The responder group initiated V reduction (ΔV) at 1 month, with remission of symptoms, and presented a 50% ΔV at 3 months of treatment; the maximum response was achieved at 24 months and remained stable until the end of the study. The non-responder group presented a ΔV of less than 50% at 12 months; though a tendency to >50% ΔV was observed at 24-36 months, there was subsequent regrowth, and 40% of this group required surgery. ΔV was positively correlated with the total administered energy/V (J/V) and inversely with nodule V. No severe adverse effects were observed. Thyroid function remained normal in all patients. Remission of symptoms occurred rapidly after 1 month. CONCLUSIONS: LA with multiple fractional discharges employing a single fiber in a unique session is a safe and inexpensive technique that allows rapid reduction of thyroid nodules, with a stable response up to 5 years, similarly to what has been reported with the conventional LA. Total nodule volume appears as a predictive factor of the reduction.

The LUCA device: a multi-modal platform combining diffuse optics and ultrasound imaging for thyroid cancer screening.

We present the LUCA device, a multi-modal platform combining eight-wavelength near infrared time resolved spectroscopy, sixteen-channel diffuse correlation spectroscopy and a clinical ultrasound in a single device. By simultaneously measuring the tissue hemodynamics and performing ultrasound imaging, this platform aims to tackle the low specificity and sensitivity of the current thyroid cancer diagnosis techniques, improving the screening of thyroid nodules. Here, we show a detailed description of the device, components and modules. Furthermore, we show the device tests performed through well established protocols for phantom validation, and the performance assessment for in vivo. The characterization tests demonstrate that LUCA device is capable of performing high quality measurements, with a precision in determining in vivo tissue optical and dynamic properties of better than 3%, and a reproducibility of better than 10% after ultrasound-guided probe repositioning, even with low photon count-rates, making it suitable for a wide variety of clinical applications.

Applicability of sentinel lymph node biopsy in papillary thyroid cancer.

BACKGROUND: The optimal surgical management of papillary thyroid cancer (PTC) for T1-T2 tumors without pre or intrasurgical evidence of lymph node metastasis (cN0) remains controversial, since approximately 40% of patients have lymph node involvement (pN1) which becomes evident when a prophylactic lymphadenectomy (PL) is performed. The aim of this study was to investigate the feasibility of sentinel lymph node (SLN) identification with SPECT/CT lymphoscintigraphy imaging along with intraoperatory image techniques in early stages of PTC undergoing PL of central neck compartment (CNC). METHODS: A single-center, prospective consecutive study was designed for SLN mapping in patients with high suspicion of PTC (Bethesda V or VI) in early stage (cT1-2, cN0). Twenty-four patients underwent SLN identification with preoperative SPECT/CT and planar images (99mTc-nanocolloid albumin intratumoral injection). During surgery, SLN located in CNC was found by means of a gamma probe and portable gamma camera, and excised. Afterwards, CNC lymphadenectomy was performed in all cases without modifying the established protocol. RESULTS: SLNs were identified and accurately located in 23 (95.8%) patients. Nodal metastases (pN1) were confirmed in 9 (37.5%) patients, with one false negative case. The sensitivity was 88.9% and negative predictive value (NPV) was 93.3%, would have allowed to avoid PL in more than half of cases, a higher proportion than those found in other similar studies. No complications associated with the procedure were observed. CONCLUSIONS: Our results support that SLN biopsy by SPECT/CT along with intraoperatory image techniques is applicable in early stages of PTC (cT1-2, cN0), allowing to avoid unnecessary PL.

Systematic study of the effect of ultrasound gel on the performances of time-domain diffuse optics and diffuse correlation spectroscopy.

Recently, multimodal imaging has gained an increasing interest in medical applications thanks to the inherent combination of strengths of the different techniques. For example, diffuse optics is used to probe both the composition and the microstructure of highly diffusive media down to a depth of few centimeters, but its spatial resolution is intrinsically low. On the other hand, ultrasound imaging exhibits the higher spatial resolution of morphological imaging, but without providing solid constitutional information. Thus, the combination of diffuse optical imaging and ultrasound may improve the effectiveness of medical examinations, e.g. for screening or diagnosis of tumors. However, the presence of an ultrasound coupling gel between probe and tissue can impair diffuse optical measurements like diffuse optical spectroscopy and diffuse correlation spectroscopy, since it may provide a direct path for photons between source and detector. A systematic study on the effect of different ultrasound coupling fluids was performed on tissue-mimicking phantoms, confirming that a water-clear gel can produce detrimental effects on optical measurements when recovering absorption/reduced scattering coefficients from time-domain spectroscopy acquisitions as well as particle Brownian diffusion coefficient from diffuse correlation spectroscopy ones. On the other hand, we show the suitability for optical measurements of other types of diffusive fluids, also compatible with ultrasound imaging.

Preservación de corteza adrenal funcionante. Una buena razón para realizar un abordaje endoscópico retroperitoneal posterior / Functional adrenal cortex preservation: A good reason for posterior retroperitoneal endoscopic approach

INTRODUCCIÓN: La adrenalectomía con preservación cortical se indica como tratamiento del feocromocitoma bilateral hereditario y esporádico, en casos de bajo riesgo de malignidad, para reducir la posibilidad de insuficiencia suprarrenal asumiendo la eventualidad de una recidiva local. El objetivo del estudio es analizar los resultados funcionales de la adrenalectomía parcial por vía endoscópica retroperitoneal en pacientes monoadrenales o que necesiten una adrenalectomía bilateral. MÉTODOS: Entre enero de 2015 y febrero de 2016 se incluyeron de forma prospectiva pacientes con feocromocitoma asociado a mutaciones con bajo riesgo para malignidad, que aceptaron participar en el estudio. Todos fueron operados por cirujanos especialmente entrenados en este tipo de cirugía, utilizando la misma técnica quirúrgica. Se recogieron variables demográficas y características clínicas, realizando posteriormente el análisis descriptivo de dichas variables. RESULTADOS: Se registraron un total de 6 pacientes, cuatro asociados al síndrome MEN tipo 2 y dos en contexto del síndrome VHL. No fue precisa ninguna conversión a abordaje laparoscópico o abierto y tampoco complicaciones postoperatorias, la estancia hospitalaria media fue de 2,5 días. Se logró la preservación de corteza adrenal funcionante sin requerimiento corticoideo en 5 (83%) de 6 casos. Con un seguimiento medio de 26,2 ± 6 meses, estos 5 pacientes presentan una función adrenal conservada sin aporte hormonal sustitutivo. CONCLUSIONES: La adrenalectomía con preservación cortical por vía endoscópica retroperitoneal, en manos expertas, es segura y factible para el tratamiento del feocromocitoma hereditario y esporádico en contexto de baja malignidad, permitiendo evitar la necesidad de aporte corticoideo en la mayoría de los casos

INTRODUCTION: Cortical-sparing adrenalectomy is a suitable treatment for hereditary and sporadic bilateral pheochromocytoma, in cases of low risk of malignancy, to reduce the possibility of adrenal insufficiency assuming the chance of local recurrence. The aim of the study is to analyze the functional results of partial adrenalectomy by retroperitoneal endoscopic approach in single-adrenal patients or patients requiring bilateral adrenalectomy. METHODS: Prospective study between January 2015 and February 2016 including pheochromocytoma patients diagnosed with low risk of malignant mutations. All patients agreed to be included in the study. Experienced endocrine surgeons who have been trained in minimally invasive endocrine surgery performed the procedure using the same surgical technique. Demographic variables and clinical characteristics were collected, subsequently carrying out the descriptive analysis of the data. RESULTS: A total of 6 patients were registered, four associated with MEN type 2 syndrome and two in the context of VHL syndrome. Retroperitoneoscopic resection was performed without laparoscopic or open conversion and no postoperative complications; the average hospital stay was 2.5 days. Preservation of the functional cortex without corticosteroids was achieved in 5 (83%) of out 6 cases with a follow-up of 26.2 ± 6 months. Today, these 5 patients have a preserved adrenal function without hormone replacement. CONCLUSIONS: Cortical-sparing adrenalectomy by the retroperitoneal endoscopic approach, in expert hands, is safe and feasible for the treatment of hereditary and sporadic pheochromocytoma in a context of low malignancy, making it possible to avoid the need for corticoid replacement in most cases

Functional adrenal cortex preservation: A good reason for posterior retroperitoneal endoscopic approach. / Preservación de corteza adrenal funcionante. Una buena razón para realizar un abordaje endoscópico retroperitoneal posterior.

INTRODUCTION: Cortical-sparing adrenalectomy is a suitable treatment for hereditary and sporadic bilateral pheochromocytoma, in cases of low risk of malignancy, to reduce the possibility of adrenal insufficiency assuming the chance of local recurrence. The aim of the study is to analyze the functional results of partial adrenalectomy by retroperitoneal endoscopic approach in single-adrenal patients or patients requiring bilateral adrenalectomy. METHODS: Prospective study between January 2015 and February 2016 including pheochromocytoma patients diagnosed with low risk of malignant mutations. All patients agreed to be included in the study. Experienced endocrine surgeons who have been trained in minimally invasive endocrine surgery performed the procedure using the same surgical technique. Demographic variables and clinical characteristics were collected, subsequently carrying out the descriptive analysis of the data. RESULTS: A total of 6 patients were registered, four associated with MEN type 2 syndrome and two in the context of VHL syndrome. Retroperitoneoscopic resection was performed without laparoscopic or open conversion and no postoperative complications; the average hospital stay was 2.5 days. Preservation of the functional cortex without corticosteroids was achieved in 5 (83%) of out 6 cases with a follow-up of 26.2 ± 6 months. Today, these 5 patients have a preserved adrenal function without hormone replacement. CONCLUSIONS: Cortical-sparing adrenalectomy by the retroperitoneal endoscopic approach, in expert hands, is safe and feasible for the treatment of hereditary and sporadic pheochromocytoma in a context of low malignancy, making it possible to avoid the need for corticoid replacement in most cases.

Primary adrenal insufficiency due to hereditary apolipoprotein AI amyloidosis: endocrine involvement beyond hypogonadism.

Several mutations in the gene encoding apolipoprotein AI (apoAI) have been described as a cause of familial amyloidosis. Individuals with apoAI-derived (AApoAI) amyloidosis frequently manifest with liver, kidney, laryngeal, skin and myocardial involvement. Although primary hypogonadism (PH) is considered almost pathognomonic of this disease, until now, primary adrenal insufficiency (PAI) has not been described as a common clinical feature. Here, we report the first kindred with AApoAI amyloidosis in which PAI is well-documented. All family members with the Leu60_Phe71delins60Val_61Thr heterozygous mutation who were regularly followed-up at our centre were considered. Nineteen individuals had the confirmed APOA1 deletion/insertion mutation, with detailed medical records available in 11 cases. Of these, 6 had PAI and 3 (all males) had PH. Among them, one 47-year-old man, not previously diagnosed with PAI, developed adrenal crisis after liver transplantation, precipitated by an opportunistic infection. Transplantation due to organ failure, which necessitates use of immunosuppressive medication such as corticosteroids, is frequently required during the course of hereditary amyloidosis. Consequently, PAI can remain masked, being discovered only when an adrenal crisis develops. Therefore, according to the present evidence, patients with AApoAI amyloidosis should be submitted to regular testing of corticotrophin and cortisol levels in order to avoid delaying corticosteroid replacement.

Diffuse Optical Characterization of the Healthy Human Thyroid Tissue and Two Pathological Case Studies.

The in vivo optical and hemodynamic properties of the healthy (n = 22) and pathological (n = 2) human thyroid tissue were measured non-invasively using a custom time-resolved spectroscopy (TRS) and diffuse correlation spectroscopy (DCS) system. Medical ultrasound was used to guide the placement of the hand-held hybrid optical probe. TRS measured the absorption and reduced scattering coefficients (µa, µs') at three wavelengths (690, 785 and 830 nm) to derive total hemoglobin concentration (THC) and oxygen saturation (StO2). DCS measured the microvascular blood flow index (BFI). Their dependencies on physiological and clinical parameters and positions along the thyroid were investigated and compared to the surrounding sternocleidomastoid muscle. The THC in the thyroid ranged from 131.9 µM to 144.8 µM, showing a 25-44% increase compared to the surrounding sternocleidomastoid muscle tissue. The blood flow was significantly higher in the thyroid (BFIthyroid = 16.0 × 10-9 cm2/s) compared to the muscle (BFImuscle = 7.8 × 10-9 cm2/s), while StO2 showed a small (StO2, muscle = 63.8% to StO2, thyroid = 68.4%), yet significant difference. Two case studies with thyroid nodules underwent the same measurement protocol prior to thyroidectomy. Their THC and BFI reached values around 226.5 µM and 62.8 × 10-9 cm2/s respectively showing a clear contrast to the nodule-free thyroid tissue as well as the general population. The initial characterization of the healthy and pathologic human thyroid tissue lays the ground work for the future investigation on the use of diffuse optics in thyroid cancer screening.

The truncated isoform of somatostatin receptor5 (sst5TMD4) is associated with poorly differentiated thyroid cancer.

Somatostatin receptors (ssts) are expressed in thyroid cancer cells, but their biological significance is not well understood. The aim of this study was to assess ssts in well differentiated (WDTC) and poorly differentiated thyroid cancer (PDTC) by means of imaging and molecular tools and its relationship with the efficacy of somatostatin analog treatment. Thirty-nine cases of thyroid carcinoma were evaluated (20 PDTC and 19 WDTC). Depreotide scintigraphy and mRNA levels of sst-subtypes, including the truncated variant sst5TMD4, were carried out. Depreotide scans were positive in the recurrent tumor in the neck in 6 of 11 (54%) PDTC, and in those with lung metastases in 5/11 cases (45.4%); sst5TMD4 was present in 18/20 (90%) of PDTC, being the most densely expressed sst-subtype, with a 20-fold increase in relation to sst2. In WDTC, sst2 was the most represented, while sst5TMD4 was not found; sst2 was significantly increased in PDTC in comparison to WDTC. Five depreotide positive PDTC received octreotide for 3-6 months in a pilot study with no changes in the size of the lesions in 3 of them, and a significant increase in the pulmonary and cervical lesions in the other 2. All PDTC patients treated with octreotide showed high expression of sst5TMD4. ROC curve analysis demonstrated that only sst5TMD4 discriminates between PDTC and WDTC. We conclude that sst5TMD4 is overexpressed in PDTC and may be involved in the lack of response to somatostatin analogue treatment.

Advantages of pinhole collimator double-phase scintigraphy with 99mTc-MIBI in secondary hyperparathyroidism.

PURPOSE: The aim of the study was to determine if pinhole collimator-acquired images can improve the detection of hyperfunctioning parathyroid glands in patients with secondary hyperparathyroidism. METHODS: Forty-two patients being treated with cinacalcet for secondary hyperparathyroidism were studied prospectively. Patients were divided into 2 groups according to their levels of parathyroid hormone (PTH), the hormone that defines response to treatment: "responders" (PTH <300 pg/mL) and "nonresponders" (PTH ≥ 300 pg/mL). Double-phase scintigraphy using 888 MBq of (99m)Tc-MIBI was used to acquire early and late parallel-hole and pinhole collimator images. Neck ultrasonography was performed on all patients to identify intrathyroid nodules. All focal uptake in any of the acquired scintigraphic images was considered positive. RESULTS: The responder group included 24 patients, whereas 18 patients were considered as nonresponders. At least 1 parathyroid gland with (99m)Tc-MIBI uptake was detected in 33 of 42 patients, with a total of 50 parathyroid glands located. We found significant differences between the detection rates of late pinhole collimator and the late parallel-hole images (74% vs 48%, P = 0.0036). This detection rate was highest with late parallel-hole images in the nonresponder group (89%). CONCLUSIONS: The late pinhole collimator acquisition showed the highest detection rate of hyperfunctioning parathyroid glands using (99m)Tc-MIBI scintigraphy in secondary hyperparathyroidism patients treated with cinacalcet.

T2 hypointense rims and ring-enhancing lesions in MS.

BACKGROUND: Hypointense rims peripherally on T2-weighted MRI (rim lesions) have been associated with gadolinium ring-enhancing lesions in multiple sclerosis (MS) in pathological studies. However, little is known about their frequency, we analyzed clinical significance in a cohort of MS sufferers according to routine clinical practice. METHODS: We retrospectively reviewed all available MRI scans performed on our MS patients between 2000 and 2009. A total of 580 MRI scans from 257 patients were analyzed. The presence of rim lesions and ring enhancement was assessed and counted blind. Furthermore, the correlation between both patterns, and with clinical characteristics, was evaluated. RESULTS: Thirty-five rim lesions were identified and 9% (24/257) of the patients showed at least one of these lesions. Forty ring-enhancing lesions were counted and 12% (29/245) of the patients who had undergone gadolinium MRI presented at least one such lesion. Thirteen lesions co-localized both patterns (40% of the rim lesions and 33% of the ring-enhancing lesions). Rim lesions and ring-enhancing lesions were observed in patients with clinically isolated syndrome (7%, 7%), relapsing-remitting (11%, 15%) and secondary progressive (13%, 9%) but none with primary progressive MS. Presence of ring-enhancing lesions was significantly associated with a shorter time to reach EDSS (Expanded Disability Status Scale) 4.0 and 6.0 (hazard ratio 7.6, 95% confidence interval 2.3-24.6). CONCLUSIONS: Rim lesions and ring-enhancing lesions are present in close to 10% of patients with MS, and frequently both lesions appear independently one to the other. The association of ring enhancement with worst prognosis needs to be confirmed in prospective studies.

Preoperative assessment of cutaneous melanoma thickness using 10-MHz sonography.

OBJECTIVE: The purpose of this study was to evaluate the prognostic value of 10-MHz sonography in measuring melanoma thickness before biopsy or excision. SUBJECTS AND METHODS: Fifty-four patients with lesions suggestive of melanoma participated in the study. Lesions were measured on sonography using a 10-MHz linear transducer before routine biopsy and histopathologic analysis. Sonographic measurements were compared with histopathologic results (Breslow index) using Pearson's correlation coefficient and concordance analysis. Additional statistical analyses included sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 10-MHz sonography in identifying lesions > 1 mm thick. RESULTS: Histopathologic analysis identified all 54 lesions as melanoma. On sonography, 34 lesions measured < or = 1 mm and 20 lesions, > 1 mm. Histopathologic analysis showed 32 lesions with a Breslow index of < or = 1 mm and 22 lesions with a Breslow index of > 1 mm. The median thickness of the 54 lesions was 1.33 mm (range, 0-5 mm) by the Breslow index compared with 1.85 mm (range, 0-4.8 mm) by sonography. Comparison of sonographic measurements and Breslow index values gave a correlation coefficient of 0.93 and a concordance coefficient of 0.99. Overall, sonographic measurements showed 86% sensitivity, 97% specificity, 93% accuracy, 95% positive predictive value, and 91% negative predictive value in identifying lesions with a Breslow index of > 1 mm. CONCLUSION: In our series of 54 melanomas, 10-MHz sonography measured lesion thickness with good accuracy compared with histopathology. Sonography was effective in discriminating between tumors < or = 1 mm thick and those > 1 mm thick.

Ecografía con contraste de segunda generación (SonoVue) en la valoración del tratamiento percutáneo del carcinoma hepatocelular. Comparación con la TC multifásica / Second-generation ultrasound contrast agents (SonoVue) in the evaluation of percutaneous treatment of hepatocellular carcinoma: comparison with multiphase CT

Objetivo: Determinar la eficacia de la ecografía con contraste (EC) de segunda generación en la valoración del tratamiento percutáneo del carcinoma hepatocelular (CHC), tanto de una forma precoz (< 24 h), como al mes después del tratamiento. Asimismo, se analiza la utilidad de la tomografía computarizada (TC) en la valoración inmediata después del tratamiento, hecho cuestionado hasta el momento. Material y métodos: Se han incluido en el estudio 30 pacientes afectados de CHC de pequeño tamaño, no tributarios de resección quirúrgica, tratados mediante alcoholización o radiofrecuencia. Antes del tratamiento, pasadas menos de 24 h de tratamiento, y 1 mes postratamiento efectuaron una EC (con software especial de contrastes y bajo índice mecánico) y una TC multifásica. Se compararon los hallazgos de las exploraciones a las 24 h (EC y TC) y los de la EC 1 mes postratamiento con los de la TC al mes (gold standar).Resultados: Valorado con TC al mes, el tratamiento percutáneo obtuvo una respuesta completa en 22 de los 30 pacientes. La EC y la TC realizadas antes de las 24 h postratamiento obtuvieron, respectivamente, los siguientes resultados: sensibilidad (S), 12,5 (28,5%); especificidad (E), 95,4 (95,4%); rentabilidad diagnóstica (RD), 73,3 (79,3%); valor predictivo positivo (VPP), 50 (66%); valor predictivo negativo (VPN), 75 (80,6%). Los resultados de la EC realizada al mes postratamiento fueron: S, 87,5%; E, 95,4%; RD, 93,3%; VPP, 87,5%, y VPN, 95,4%.Conclusión: La EC y la TC realizadas antes de las 24 h postratamiento tienen escasa utilidad para detectar la persistencia tumoral valorada de forma inmediata postratamiento. Dados los buenos resultados de la EC realizada al mes postratamiento, esta exploración podría sustituir a la TC para valorar la necesidad de nuevos tratamientos

Objective: to determine the efficacy of ultrasonography using second-generation contrast agents (CUS) in the evaluation of percutaneous treatment of hepatocellular carcinoma (HCC), both for early evaluation (< 24 hours) and for evaluation one month after treatment. Likewise, the usefulness of computerized tomography (CT) for evaluation immediately after treatment, to date controversial, is assessed. Material and methods: A total of 30 patients with small-sized HCC without indications for surgery treated by radiofrequency ablation or alcohol injection were included in the study. All patients underwent CUS (using special contrast software and low mechanical index) and multiphase CT prior to treatment, within 24 hours of treatment, and one month after treatment. CT findings one month after treatment were taken as the gold standard. Findings at CUS and CT examination within 24 hours of treatment and CUS findings at one month were compared with the gold standard. Results: CT performed one month after percutaneous treatment found a complete response in 22 of the 30 patients. Comparison of CUS and CT findings within 24 hours of treatment with the gold standard yielded the following results: (CUS/CT) Sensitivity (S) = 12.5/28.5%, specificity (SP) = 95.4/95.4%, diagnostic yield (DY) = 73.3/79.3%, positive predictive value (PPV) = 50/66%, negative predictive value (NPV) = 75/80.6%. The results of CUS performed one month after treatment were : S = 87.5%, SP = 95.4%, DY = 93.3%, PPV = 87.5% and NPV = 95.4%.Conclusion: CUS and CT performed within 24 hours of treatment are of little use in detecting tumor persistence immediately after treatment. Given the good results obtained using CUS one month after treatment, this technique could substitute CT to assess the need for retreatment