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1.
Vet Clin North Am Food Anim Pract ; 37(1): 55-74, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33541702

RESUMEN

Ultrasonography and radiography are the most frequently used imaging techniques to evaluate abdominal pathology in domestic animals. Ultrasonography can often achieve a diagnosis in small ruminants, with ease of use and virtually no contraindications. Radiography also provides a relatively comprehensive overview, but reduced penetration of the abdomen in larger animals and summation of abdominal organs can limit its diagnostic value. Computed tomography is a newer imaging modality that provides summation-free imaging but can have limited availability and financial restrictions.


Asunto(s)
Abdomen/diagnóstico por imagen , Enfermedades de las Cabras/diagnóstico por imagen , Enfermedades de las Ovejas/diagnóstico por imagen , Animales , Tracto Gastrointestinal/diagnóstico por imagen , Cabras/anatomía & histología , Hígado/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Rumiantes , Ovinos/anatomía & histología , Bazo/diagnóstico por imagen , Bazo/patología , Tomografía Computarizada por Rayos X/veterinaria , Ultrasonografía/veterinaria
2.
Medicine (Baltimore) ; 100(4): e23636, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530167

RESUMEN

BACKGROUND: Early stage of cirrhosis is of great value in the diagnosis and management in patients with chronic liver disease (CLD). Recent studies have shown that quantitative liver surface nodularity (LSN) score based on imaging techniques can be used to predict the early cirrhosis stage noninvasively, with varied diagnostic accuracy and limited sample size. Hence, this study will evaluate the diagnostic accuracy of LSN in the prediction of early cirrhosis. METHODS: We will conduct a comprehensive search in PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases to identify eligible studies. The literature screening, data extraction, data analysis, and quality assessment will then be carried out. The summary receiver-operating-characteristic (ROC) and pooled sensitivity, specificity will be calculated to summarize the diagnostic performance of LSN using a random-effect model. A meta-regression analysis will be performed to investigate the underlying cause of the heterogeneity. RESULTS: This study will evaluate the diagnostic accuracy of LSN score in the identification of early cirrhosis, which may further determine whether this method can be used as an alternative in the assessment of CLD patients. CONCLUSIONS: This study will help to determine the diagnostic accuracy and summarize the recent evidence on this issue. STUDY REGISTRATION: INPLASY2020100096.


Asunto(s)
Cirrosis Hepática/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Biomarcadores/análisis , Enfermedad Crónica , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Cirrosis Hepática/etiología , Hepatopatías/complicaciones , Metaanálisis como Asunto , Valor Predictivo de las Pruebas , Curva ROC , Proyectos de Investigación , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Revisiones Sistemáticas como Asunto
3.
BMC Surg ; 21(1): 71, 2021 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-33530973

RESUMEN

BACKGROUND: Hemobilia due to rupture of hepatic artery pseudoaneurysm and recurrent hemorrhage caused by hepatic artery collateral circulation are both rare complications after liver trauma. There have been a number of separate reports of both complications, but no cases have been reported in which the two events occurred in the same patient. Here we report a recurrent hemorrhage in the bile duct due to hepatic artery pseudoaneurysm secondary to collateral circulation formation after hepatic artery ligation in a patient with liver trauma. CASE PRESENTATION: A 52-year-old male patient was admitted to our hospital for liver trauma (Grade IV according to the American Association for the Surgery of Trauma (AAST) grading system) with active bleeding after a traffic accident. Hepatic artery ligation was performed for hemostasis. Three months after the surgery, the patient was readmitted for melena and subsequent hematemesis. Selective angiography examination revealed the formation of collateral circulation between the superior mesenteric artery and right hepatic artery. Moreover, a ruptured hepatic artery pseudoaneurysm was observed and transcatheter arterial embolization (TAE) was performed for hemostasis at the same time. After the treatment, the patient recovered very well and had an uneventful prognosis until the last follow-up. CONCLUSION: For patients with hepatic trauma, the selection of the site of hepatic artery ligation and the diagnosis and treatment methods of postoperative biliary hemorrhage are crucial for the prognosis of the disease.


Asunto(s)
Aneurisma Falso , Aneurisma Roto , Hemobilia , Arteria Hepática , Ligadura/efectos adversos , Hígado , Traumatismos Abdominales/complicaciones , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Aneurisma Roto/etiología , Aneurisma Roto/terapia , Angiografía/métodos , Conductos Biliares/diagnóstico por imagen , Conductos Biliares/lesiones , Circulación Colateral , Embolización Terapéutica , Hematemesis/etiología , Hematemesis/terapia , Hemobilia/etiología , Hemobilia/terapia , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/lesiones , Arteria Hepática/cirugía , Humanos , Hígado/irrigación sanguínea , Hígado/diagnóstico por imagen , Hígado/lesiones , Masculino , Melena/etiología , Melena/terapia , Persona de Mediana Edad , Recurrencia , Circulación Esplácnica
4.
Z Gastroenterol ; 59(2): 149-152, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33556974

RESUMEN

We report the case of a 62-year-old Caucasian male patient who presented with epigastric pain to our outpatient clinic. On abdominal ultrasound we detected a 26 mm oval hypoechoic lesion in segment 2 of the left liver lobe. Performing contrast-enhanced ultrasound this lesion showed an arterial hypervascularization with centripetal filling and a spoke wheel pattern. Due to a hyperenhancement during the portal and late phase this lesion led to the diagnosis of a benign liver tumor, probably a hepatocellular adenoma (HCA). As focal nodular hyperplasia (FNH) was still another possible diagnosis, we decided to perform an MRI, which could not differentiate between HCA and hepatocellular carcinoma (HCC). Therefore, we performed liver biopsy of this lesion. Histology and immunohistochemistry led to the final diagnosis of intrahepatic splenosis. Reassessment of patient history revealed an abdominal trauma with splenic rupture 5 years ago. Intrahepatic splenosis should be considered as an important differential diagnosis in patients with unknown liver tumor and a history of splenic trauma.


Asunto(s)
Imagen por Resonancia Magnética , Esplenosis/patología , Abdomen/diagnóstico por imagen , Adenoma de Células Hepáticas , Carcinoma Hepatocelular , Medios de Contraste , Diagnóstico Diferencial , Humanos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Ultrasonografía/métodos
5.
Medicine (Baltimore) ; 100(3): e24411, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546085

RESUMEN

BACKGROUND: Superb microvascular imaging (SMI) is a new ultrasound vascular imaging technology, which uses a new Doppler algorithm, it has the characteristics of high sensitivity and high resolution to detect low velocity blood flow; it is easier to detect microvessels with low-velocity flow compared with color Doppler flow imaging in theory; and it can image the microvessels of the lesion without angiography.[1] Previous studies showed that SMI can detect tumor neovascularization to differentiate benign from malignant focal liver lessions (FLLs). However, the results of these studies have been contradictory with low sample sizes. This meta-analysis tested the hypothesis that SMI is accurate in distinguishing benign and malignant FLLs. METHODS: We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the November 30, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis. RESULTS: This systematic review will determine the accuracy of SMI in the differential diagnosis between benign and malignant FLLs. CONCLUSION: Its findings will provide helpful evidence for the accuracy of SMI in the differential diagnosis between benign and malignant FLLs. SYSTEMATIC REVIEW REGISTRATION: INPLASY2020120081.


Asunto(s)
Protocolos Clínicos , Hígado/anomalías , Hígado/diagnóstico por imagen , Ultrasonografía/métodos , Ultrasonografía/normas , Velocidad del Flujo Sanguíneo/fisiología , Humanos , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto
6.
BMC Surg ; 21(1): 2, 2021 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-33388034

RESUMEN

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. CASE PRESENTATION: We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis. CONCLUSION: A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.


Asunto(s)
Carcinoma Hepatocelular/complicaciones , Neoplasias Hepáticas/complicaciones , Hígado/diagnóstico por imagen , Tuberculosis Hepática/complicaciones , Dolor Abdominal/etiología , Carcinoma Hepatocelular/diagnóstico , Femenino , Fiebre/etiología , Humanos , Hígado/patología , Neoplasias Hepáticas/diagnóstico , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Tuberculosis Hepática/diagnóstico
7.
Medicine (Baltimore) ; 100(2): e24242, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466207

RESUMEN

RATIONALE: The drastic differences in treatment and prognosis of infantile hepatic hemangioma (IHH) and hepatoblastoma (HBL) make accurate prenatal diagnosis imperative. The retrospective comparisons of ultrasonic features between fetal IHH and HBL have been reported before, but clinically, the differential diagnosis in utero is very difficult and can lead to prenatal misdiagnosis. PATIENT CONCERNS: A 27-year-old woman at 30 gestational weeks underwent the routine prenatal examination. A heterogeneous solid mass of the fetus, with close relationship to the liver, was recognized by ultrasound. DIAGNOSIS: A diagnosis of HBL was highly considered. INTERVENTIONS: The fetus was aborted and the autopsy was performed. OUTCOMES: The histological outcome was IHH. LESSONS: The prognosis of fetal IHH and HBL is very different, so an accurate diagnosis prenatally is crucial and indispensable. The radiologist and clinician should differentiate between IHH and HBL, especially since the fetus can have serious complications.


Asunto(s)
Hemangioma/diagnóstico , Hepatoblastoma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Ultrasonografía Prenatal , Aborto Inducido , Adulto , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Feto/diagnóstico por imagen , Hemangioma/embriología , Hepatoblastoma/embriología , Humanos , Hígado/irrigación sanguínea , Hígado/diagnóstico por imagen , Hígado/embriología , Neoplasias Hepáticas/embriología , Embarazo , Estudios Retrospectivos
10.
BMC Surg ; 21(1): 57, 2021 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-33485329

RESUMEN

BACKGROUND: To determine the standard remnant liver volume (SRLV) threshold to avoid postoperative hepatic insufficiency inpatients in different stages of hepatic fibrosis who undergo right hemi-hepatectomy. METHODS: Data for 85 patients at our single medical center were analysed prospectively to examine whether the following factors differed significantly between those who experienced postoperative hepatic insufficiency and those who did not: height, prothrombin time, remnant liver volume, SRLV or hepatic fibrosis stage. RESULTS: Logistic regression showed SRLV and hepatic fibrosis stage to be independent risk factors for postoperative hepatic insufficiency. The threshold SRLV for predicting insufficiency was 203.2 ml/m2 across all patients [area under receiver operating characteristic curve (AUC) 0.778, sensitivity 66.67%, specificity 83.64%, p<0.0001), 193.8 ml/m2 for patients with severe hepatic fibrosis (AUC 0.938, sensitivity 91.30%, specificity 85.71%, p<0.0001), and 224.3 ml/m2 for patients with cirrhosis (AUC 0.888, sensitivity 100%, specificity 64.29%, p<0.0001). CONCLUSIONS: Right hemi-hepatectomy may be safer in Chinese patients when the standard remnant liver volume is more than 203.2 ml/m2 in the absence of hepatic fibrosis or cirrhosis, 193.8 ml/m2 in the presence of severe hepatic fibrosis or 224.3 ml/m2 in the presence of cirrhosis.


Asunto(s)
Carcinoma Hepatocelular , Hepatectomía/efectos adversos , Cirrosis Hepática , Neoplasias Hepáticas , Hígado , Adulto , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Simulación por Computador , Femenino , Hepatectomía/métodos , Insuficiencia Hepática/etiología , Insuficiencia Hepática/prevención & control , Humanos , Imagenología Tridimensional , Hígado/diagnóstico por imagen , Hígado/patología , Hígado/cirugía , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Estándares de Referencia , Valores de Referencia , Factores de Riesgo , Tomografía Computarizada por Rayos X
11.
Br J Radiol ; 94(1118): 20200163, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33353395

RESUMEN

OBJECTIVE: This study aimed to develop a predictive risk model for post-ablation hemobilia. METHODS: This was a retrospective, multicenter, matched case-control study. The case group comprised patients with hepatocellular carcinoma who developed post-ablation hemobilia (n = 21); the control group (n = 63) comprised patients with hepatocellular carcinoma but no post-ablation hemobilia; for each case, we included three controls matched for age, sex, platelet count, year of ablation therapy, and center. Univariate and multivariate regression analyses were performed to identify the risk factors for hemobilia. A risk score model was developed based on adjusted odds ratios (ORs). RESULTS: The independent risk factors for occurrence of post-ablation hemobilia were maximum tumor diameter >47 mm [OR = 5.983, 95% CI (1.134-31.551)] and minimum distance from the applicator to the portal trunk ≤8 mm [OR = 4.821, 95% CI (1.225-18.975)]. The risk model was developed using the adjusted ORs; thus a score of 6 was assigned to the former and a score of 5 for the latter. The area under the curve of this risk model was 0.76. Significant hemodynamic instability and inaccurate embolization might increase the risk of recurrence of hemobilia. CONCLUSION: Tumor size >47 mm and distance of the applicator from the portal trunk ≤8 mm are independent risk factors for hemobilia. A predictive risk model for post-ablation hemobilia was developed using these risk factors. ADVANCES IN KNOWLEDGE: This is the first study that developed a risk score model of post-ablation hemobilia. Risk factors of the recurrence of post-ablation hemobilia were also been identified.


Asunto(s)
Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Ablación por Catéter/métodos , Hemobilia/diagnóstico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Carcinoma Hepatocelular/diagnóstico por imagen , Estudios de Casos y Controles , Femenino , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Hígado/cirugía , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Modelos Teóricos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Carga Tumoral
12.
Sci Total Environ ; 750: 141231, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33182180

RESUMEN

Contrast-enhanced ultrasound (CEUS) imaging has great potential as a non-lethal, inexpensive monitoring tool in aquatic toxicology. It is a well-established clinical imaging approach that combines real-time, quantitative assessment of organ blood flow, with morphological data. In humans, it has been extensively used to measure changes in blood flow that can be attributed to cancer, inflammation, and other biological abnormalities. However, it has yet to be explored as a tool for fish physiology or environmental toxicology. In this study, our goal was to determine if CEUS could be used to visualize and measure blood flow in the liver of a rainbow trout. All rainbow trout received two injections of an ultrasound contrast agent, microbubbles. A subset received a third injection after administration of propranolol, a non-specific beta1 & 2-blocker, to determine if changes in blood flow could be detected. Ultrasound contrast time-intensity curves (TIC) were obtained, fit to a lognormal model, and different perfusion parameters were calculated. Contrast enhancement was observed in all rainbow trout livers, with high percentage between repeated measurements, including blood flow (80.6 ± 27.3%), area under the curve (73.2 ± 14%), blood volume (84 ± 14.2%) and peak enhancement (86.7 ± 7.5%). After administration of propranolol, we detected a non-significant (p > 0.05) increase in area under the curve (102.6 ± 44.2%), peak enhancement (77.3 ± 106.4), blood volume (48.2 ± 74.5%), and decrease in hepatic blood flow (-17.3 ± 37.1%). These data suggest that CEUS imaging is suitable to measure organ blood flow in fish, and demonstrates tremendous potential for exploring different organs, fish species, and effects of chemical contaminants in future studies.


Asunto(s)
Oncorhynchus mykiss , Animales , Medios de Contraste , Humanos , Hígado/diagnóstico por imagen , Propranolol , Ultrasonografía
13.
Clin Imaging ; 69: 228-232, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32971452

RESUMEN

We describe a unique case of focal nodular hyperplasia (FNH) in a 6-month-old-girl with elevated alpha-fetoprotein (AFP). Given the patient's age and elevated AFP, a diagnosis of hepatoblastoma was presumed. However, the histopathologic assessment of the lesion was typical for focal nodular hyperplasia. This was further corroborated using hepatobiliary contrast agent to exclude the possibility of a collision or a composite liver tumor.


Asunto(s)
Hiperplasia Nodular Focal , Hepatoblastoma , Neoplasias Hepáticas , Medios de Contraste , Femenino , Hiperplasia Nodular Focal/diagnóstico por imagen , Humanos , Lactante , Hígado/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , alfa-Fetoproteínas
14.
Ultrasonics ; 110: 106287, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33091652

RESUMEN

In this paper, we proposed ultrasound homodyned K (HK) imaging based on the noise-assisted correlation algorithm (NCA) for monitoring microwave ablation of porcine liver ex vivo. The NCA-based HK (αNCA and kNCA) imaging was compared with NCA-based Nakagami (mNCA) imaging and NCA-based cumulative echo decorrelation (CEDNCA) imaging. Backscattered ultrasound radiofrequency signals of porcine liver ex vivo during and after the heating of microwave ablation were collected (n = 15), which were processed for constructing B-mode imaging, NCA-based HK imaging, NCA-based Nakagami imaging, and NCA-based CED imaging. To quantitatively evaluate the final coagulation zone, the polynomial approximation (PAX) technique was applied. The accuracy of detecting coagulation area with αNCA, kNCA, mNCA, and CEDNCA parametric imaging was evaluated by comparing the PAX imaging with the gross pathology. The receiver operating characteristic (ROC) curve was used to further evaluate the performance of the three quantitative ultrasound imaging methods for detecting the coagulation zone. Experimental results showed that the average accuracies of αNCA, kNCA, mNCA, and CEDNCA parametric imaging combined with PAX imaging were 89.6%, 83.25%, 89.23%, and 91.6%, respectively. The average areas under the ROC curve (AUROCs) of αNCA, kNCA, mNCA, and CEDNCA parametric imaging were 0.83, 0.77, 0.83, and 0.86, respectively. The proposed NCA-based HK imaging may be used as a new method for monitoring microwave ablation.


Asunto(s)
Técnicas de Ablación , Hígado/diagnóstico por imagen , Hígado/cirugía , Microondas/uso terapéutico , Ultrasonografía/métodos , Algoritmos , Animales , Procesamiento de Imagen Asistido por Computador , Técnicas In Vitro , Porcinos
15.
Magn Reson Imaging ; 75: 141-148, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33129937

RESUMEN

PURPOSE: To compare the correlations among the R1ρ, R2, and R2* relaxation rates with liver iron concentration (LIC) in the assessment of rat liver iron content and explore the application potential of R1ρ in assessing liver iron content. METHODS: Iron dextran (dosage of 0, 25, 50, 100, and 200 mg/kg body weight) was injected into 35 male rats to increase the amount of iron storage in the liver. After one week, all rats were euthanized with isoflurane. A portion of the largest hepatic lobe was extracted to quantify the LIC by inductively coupled plasma, and the remaining liver tissue was stored in 4% buffered paraformaldehyde for 24 h before MRI. Spin-lock preparation with a RARE (rapid acquisition with relaxation enhancement) readout (9 different spin-lock times and 7 different spin-lock frequencies (FSLs)) and multi-echo UTE (ultrashort TE) pulses were developed to quantify R1ρ and R2 * on a Bruker 11.7 T MR system. For comparisons with R1ρ and R2*, R2 was acquired using the CPMG sequence. RESULTS: Mean R1ρ values displayed dispersion, with decrease in R1ρ at higher FSLs. Spearman's correlation analysis (two-tailed) indicated that the R1ρ values were significantly associated with LIC at FSL = 2000, 2500, and 3000 Hz (r = 0.365 and P = 0.031, r = 0.608 and P < 0.001, and r = 0.764 and P < 0.001, respectively), and were not significantly associated with LIC at FSL = 500, 1000, 1250, and 1500 Hz (all P > 0.05). R2 and R2* showed significant linear correlations with LIC (r = 0.787 and P < 0.001, and r = 0.859 and P < 0.001, respectively). Correlation analysis across R1ρ, R2, and R* also suggested that the correlation strength between R1ρ and R2 and between R1ρ and R* showed an increasing trend with increase in FSL. CONCLUSION: In this study, a strong association was observed between R1ρ and LIC at high FSLs further confirming previous findings. The results demonstrated that R1ρ at high FSL might serve as a complementary imaging biomarker for liver iron overload quantification.


Asunto(s)
Hierro/metabolismo , Hígado/diagnóstico por imagen , Hígado/metabolismo , Imagen por Resonancia Magnética , Animales , Biomarcadores/metabolismo , Pruebas Diagnósticas de Rutina , Masculino , Ratas
16.
J Vis Exp ; (166)2020 12 05.
Artículo en Inglés | MEDLINE | ID: mdl-33346203

RESUMEN

Noninvasive, accurate measurement of pressures within the human body has long been an important but elusive clinical goal. Contrast agents for ultrasound imaging are gas-filled, encapsulated microbubbles (diameter < 10 µm) that traverse the entire vasculature and enhance signals by up to 30 dB. These microbubbles also produce nonlinear oscillations at frequencies ranging from the subharmonic (half of the transmit frequency) to higher harmonics. The subharmonic amplitude has an inverse linear relationship with the ambient hydrostatic pressure. Here an ultrasound system capable of performing real-time, subharmonic aided pressure estimation (SHAPE) is presented. During ultrasound contrast agent infusion, an algorithm for optimizing acoustic outputs is activated. Following this calibration, subharmonic microbubble signals (i.e., SHAPE) have the highest sensitivity to pressure changes and can be used to noninvasively quantify pressure. The utility of the SHAPE procedure for identifying portal hypertension in the liver is the emphasis here, but the technique has applicability across many clinical scenarios.


Asunto(s)
Presión Sanguínea , Medios de Contraste/química , Hipertensión Portal/diagnóstico , Hipertensión Portal/fisiopatología , Ultrasonografía/métodos , Algoritmos , Calibración , Humanos , Hipertensión Portal/diagnóstico por imagen , Hígado/diagnóstico por imagen , Microburbujas
17.
Medicine (Baltimore) ; 99(51): e23655, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33371100

RESUMEN

ABSTRACT: Hepatic neuroendocrine tumors (HNETs) are uncommon neoplasms that can be subdivided into 2 types: primary and metastatic HNETs. Due to its rarity, heterogeneity and complexity, the diagnosis, treatment modalities and prognosis are still controversial.This retrospective study reviewed the effects of tumor origins and therapeutic options on the prognosis of gastroenteropancreatic neuroendocrine tumors with liver metastasis (GEP-NETLM) and primary hepatic neuroendocrine tumors (PHNETs), providing additional evidence for clinicians evaluating patients.HNETs consisted of PHNETs and GEP-NETLM. GEP-NETLM (76.2%, 112/147) was more common, which was mainly manifested as multiple lesions in both lobes of the liver. PHNETs were relatively rare (23.8%, 35/147) and were mainly single lesion located in the right lobe of the liver. In patients with GEP-NETLM, primary tumor resection could prolong survival (P = .044). As the most widely used treatment method, systematic therapy alone could not achieve a satisfactory survival. However, the combination with hepatectomy or liver-directed therapy improved the prognosis (P = .023). As the main treatment, patients with PHNETs treated with local therapy could achieve a better prognosis (P = .049). Compared with PHNETs patients, GEP-NETLM patients with higher ki-67 index showed higher mortality and poorer prognosis (P = .006).Therefore, patients with PHNETs can be distinguished from GEP-NETLM by comprehensive imaging examinations and long-term follow-ups. The choice of appropriate treatment strategies can improve the prognosis of HNETs patients.


Asunto(s)
Neoplasias Hepáticas/secundario , Hígado/patología , Tumores Neuroendocrinos/secundario , Adulto , Anciano , Antineoplásicos/uso terapéutico , Femenino , Hepatectomía , Humanos , Hígado/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/patología , Tumores Neuroendocrinos/terapia , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia
18.
Medicine (Baltimore) ; 99(52): e23924, 2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-33350797

RESUMEN

ABSTRACT: To investigate whether MRI features could preoperatively predict local tumor progression (LTP) in patients with hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) as the first-line treatment and improve a novel predictive model through developing a nomogram including various conventional MRI parameters. 105 patients with HCCs who had received RFA were enrolled. All patients had undergone conventional MRI before RFA. Uni- and multivariable analyses for LTP were assessing using a Cox proportional hazards model. The developed MRI-based nomogram was further designed based on multivariable logistic analysis in our study and the usefulness of the developed model was validated according to calibration curves and the C-index. Rim enhancement (hazard ratio: 2.689, P = .044) and the apparent diffusion coefficient (ADC) values (hazard ratio: 0.055, P = .038) were statistically significant independent predictors of LTP after RFA at multivariable analysis. The performance of the nomogram incorporating two MRI parameters (with a C-index of 0.782) was improved compared with that based on rim enhancement and ADC alone (with C-index values of 0.630 and 0.728, respectively). The calibration curve of the MRI-based nomogram showed good conformance between evaluation and observation at 0.5, 1, and 1.5 years after RFA. The preliminary predictive model based on MRI findings including rim enhancement and ADC value could be used preoperatively to estimate the risk of LTP of HCC after RFA as the first-line treatment.


Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Hígado/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Recurrencia Local de Neoplasia/diagnóstico , Nomogramas , Ablación por Radiofrecuencia , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Femenino , Humanos , Hígado/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Pronóstico , Ablación por Radiofrecuencia/efectos adversos , Ablación por Radiofrecuencia/métodos , Reproducibilidad de los Resultados
19.
Ter Arkh ; 92(8): 73-78, 2020 Sep 03.
Artículo en Ruso | MEDLINE | ID: mdl-33346465

RESUMEN

AIM: To evaluate the frequency of liver fibrosis progression to stage 34 among patients with non-alcoholic fatty liver disease (NAFLD), type 2 diabetes and obesity, to identify predictors of severe liver fibrosis, to propose an algorithm for diagnosing fibrosis in this category of patients. MATERIALS AND METHODS: 160 patients with NAFLD, type 2 diabetes mellitus (DM) and obesity and 50 patients with NAFLD without diabetes were comprehensively examined. Patients underwent laboratory examination (clinical blood test, biochemical analysis, immunoglobulins G, M, autoantibody assay, coagulogram), liver ultrasound. All patients underwent determination of the liver fibrosis stage by two methods: the serological test FibroMax and indirect ultrasound elastometry of the liver; 40 patients underwent a liver biopsy. Statistical data processing was performed using the programming language and statistical calculations R: we used correlation analysis, multiple logistic regression method, one-way analysis of variance, multi-factor analysis, the Kruskal-Wallis method, and comparison of the number of patients using the Fisher test. RESULTS: DM is a risk factor for the liver fibrosis progression in patients with NAFLD. Significant markers of severe fibrosis in this category of patients are increased levels of GGTP, haptoglobin and alpha-2-macroglobulin, lower platelet and prothrombin levels. Obesity and isolated steatosis without steatohepatitis are not markers of severe liver fibrosis at present, but obesity can be considered a risk factor for the progression of fibrosis in the future. CONCLUSION: All patients with NAFLD in combination with diabetes need screening to detect advanced liver fibrosis: it is advisable to determine the levels of GGTP, haptoglobin and alpha-2-macroglobulin.


Asunto(s)
Diabetes Mellitus Tipo 2 , Enfermedad del Hígado Graso no Alcohólico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/epidemiología , Cirrosis Hepática/etiología , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Enfermedad del Hígado Graso no Alcohólico/patología , Obesidad/patología
20.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-33370951

RESUMEN

Non-alcoholic fatty liver disease (NAFLD) is nowadays the most common liver disease worldwide. Autoimmune hepatitis (AIH) is a relatively rare disease of the liver characterised by female predominance, circulating autoantibodies, polyclonal hypergammaglobulinaemia, interface hepatitis on histology and favourable response to immunosuppression. The possibility of an additional AIH diagnosis in patients with NAFLD (NAFLD/AIH concurrence) or the presence of AIH alone instead of a supposed NAFLD diagnosis represents a challenge for clinicians. We report herein two adult patients (a 33-year-old woman and a 59-year-old man) with a previous NAFLD diagnosis who proved finally to suffer from AIH alone. These two representative cases indicate how difficult and complicated could be sometimes the diagnosis of patients with AIH highlighting the range of disease manifestations and severity while they also underline that although NAFLD is by far the most frequent chronic liver disease this could not be always the case.


Asunto(s)
Anticuerpos Antinucleares/sangre , Hepatitis Autoinmune/diagnóstico , Síndrome Metabólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Obesidad Mórbida/complicaciones , Adulto , Anticuerpos Antinucleares/inmunología , Biopsia , Diagnóstico Diferencial , Errores Diagnósticos , Diagnóstico por Imagen de Elasticidad , Femenino , Hepatitis Autoinmune/tratamiento farmacológico , Hepatitis Autoinmune/inmunología , Hepatitis Autoinmune/patología , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Inmunosupresores/administración & dosificación , Hígado/diagnóstico por imagen , Hígado/inmunología , Hígado/patología , Pruebas de Función Hepática , Masculino , Síndrome Metabólico/inmunología , Persona de Mediana Edad , Ácido Micofenólico/administración & dosificación , Enfermedad del Hígado Graso no Alcohólico/etiología , Obesidad Mórbida/inmunología , Prednisolona/administración & dosificación
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