Mielolipoma hepático: diagnóstico y tratamiento / Hepatic myelolipoma. Diagnosis and treatment

El mielolipoma es un tumor muy poco frecuente y su localización hepática resulta excepcional. Suele cursar de forma asintomática y su diagnóstico preoperatorio puede ser complicado. A continuación se presenta un nuevo caso de mielolipoma hepático y se hace una revisión de todos los casos descritos previamente en la literatura médica, en los que se destacan las características clinicopatológicas y radiológicas de estos tumores así como las posibilidades terapéuticas (AU)

Myelolipoma is a very uncommon tumor and is extremely rare in the liver. Patients are usually asymptomatic and preoperative diagnosis is often difficult. We report a new case of hepatic myelolipoma and review all the cases previously reported in the literature. Clinicopathologic and radiologic findings, as well as therapeutic options, are discussed (AU)

Endometriosis infiltrativa profunda / Deeply infiltrating endometriosis

Presentamos el caso de una paciente con endometriosis infiltrativa profunda, previamente intervenida de endometriosis ovárica, y su manejo posterior. La clínica de la paciente fue el indicador principal de la progresión de la enfermedad y las pruebas de imagen complementarias fueron imprescindibles para el diagnóstico de certeza y la orientación del correcto abordaje quirúrgico

We present a case of deeply infiltrating endometriosis and describe its management. The patient had previously undergone surgery for ovarian endometriosis. The patient's symptoms were the main indicator of disease progression and imaging techniques were essential for accurate diagnosis and surgical management

Three-dimensional contrast-enhanced magnetic resonance angiography of congenital inferior vena cava anomalies.

BACKGROUND/PURPOSE: Congenital anomalies of the inferior vena cava (IVC) are infrequent conditions. Most are asymptomatic and incidentally discovered. However, their recognition may sometimes have relevant clinical and therapeutic implications. The purpose of this report is to emphasize the importance of accurate identification and to assess the utility of three-dimensional contrast-enhanced magnetic resonance angiography (3D contrast-enhanced MRA) in their evaluation. METHODS: We retrospectively evaluated the 3D contrast-enhanced MRA of 21 patients in whom an IVC anomaly was found. RESULTS: Five of these anomalies concerned the hepatic and prerenal segments, seven were located in the renal segment, and finally, the last nine concerned the postrenal segment. CONCLUSION: IVC anomalies are uncommon conditions which may sometimes have important clinical implications. 3D contrast-enhanced MRA is a good method not only to identify them, but also to depict them accurately and safely.

Multidetector CT in the evaluation of potential living donors for liver transplantation.

Living donor liver transplantation is increasingly being used to help compensate for the increasing shortage of cadaveric liver grafts. However, the extreme variability of the hepatic vascular systems can impede this surgical procedure. Evaluation of potential living donors was conducted in which a two-detector-row computed tomographic (CT) scanner was used to obtain arterial phase and portal dominant phase images following the intravenous injection of contrast material, after which three-dimensional maximum-intensity-projection and volume-rendered images were created. The vascular anatomy was evaluated, with special attention given to the origin and course of the artery to segment IV and the presence of variants, especially those considered relative or absolute contraindications for donation, those requiring reconstruction, or those potentially altering the surgical approach. In addition, graft and remnant liver volumes were determined and the liver parenchyma evaluated. Multidetector CT is proving to be valuable in the evaluation of potential living liver donors, contributing to donor safety and providing comprehensive information about the hepatic vascular anatomy, the liver parenchyma, and graft and remnant liver volume. This information is critical in choosing the most suitable potential donor, in surgical planning, and in obtaining an optimal graft that maintains the balance between blood supply and venous drainage.

Characterization of liver lesions with mangafodipir trisodium-enhanced MR imaging: multicenter study comparing MR and dual-phase spiral CT.

PURPOSE: To evaluate whether mangafodipir trisodium (Mn-DPDP)-enhanced magnetic resonance (MR) imaging surpasses dual-phase spiral computed tomography (CT) in differentiating focal liver lesions. MATERIALS AND METHODS: One hundred forty-five patients who had or were suspected of having focal liver lesions were included in a multicenter study and underwent dual-phase spiral CT and enhanced MR imaging. Image interpretations performed by independent experienced radiologists were compared with the final diagnosis that was based on all available clinical information (including histopathologic findings in 77 patients) and that was determined with consensus. Differences in classifications by using either enhanced MR imaging or dual-phase spiral CT were analyzed with the McNemar test, and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance of enhanced MR imaging and dual-phase spiral CT. RESULTS: Lesion classification was correct in 108 (74%) patients with enhanced MR imaging and in 83 (57%) with dual-phase spiral CT (P =.001). Lesions were correctly classified as either malignant or benign in 123 (85%) patients with enhanced MR imaging and in 98 (68%) with dual-phase spiral CT (P =.001). Classification of lesions as either hepatocellular or nonhepatocellular was correct in 130 (90%) patients with enhanced MR imaging and in 93 (64%) with dual-phase spiral CT (P =.001). These differences remained when analyses were restricted to histopathologically confirmed diagnoses. Comparison of the ROC curves illustrated that enhanced MR imaging performance surpassed that of dual-phase spiral CT. CONCLUSION: Mn-DPDP-enhanced MR imaging is superior to dual-phase spiral CT in classification of focal liver lesions.