Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study.

Background: Transarterial radioembolization (TARE) is increasingly used in patients with hepatocellular carcinoma (HCC). This treatment can induce or impair portal hypertension, leading to hepatic decompensation. TARE also promotes changes in liver and spleen volumes that may modify therapeutic decisions and outcomes after therapy. Objectives: We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors. Design: In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included. Methods: We assessed clinical (including Barcelona Clinic Liver Cancer stage, portal hypertension assessment, and liver decompensation), laboratory parameters, and liver and spleen volumes before and 6 and 12 weeks after treatment. A multivariate analysis was performed. Results: In total, 18 out of 63 (28.6%) patients had liver decompensation (ascites, variceal bleeding, jaundice, or encephalopathy) within the first 3 months after therapy, not associated with tumor progression. Clinically significant portal hypertension (CSPH) and bilobar treatment independently predicted the development of liver decompensation after TARE. A significant volume increase in the non-treated hemi-liver was observed only in patients with unilobar treatment (median volume increase of 20.2% in patients with right lobe TARE; p = 0.007), especially in those without CSPH. Spleen volume also increased after TARE (median volume increase of 16.1%; p = 0.0001) and was associated with worsening liver function scores and decreased platelet count. Conclusion: Bilobar TARE and CSPH may be associated with an increased risk of liver decompensation in patients with intermediate or advanced HCC. A careful assessment considering these variables before therapy may optimize candidate selection and improve treatment planning.

Diagnóstico por la imagen de la recidiva bioquímica en el cáncer de próstata después del tratamiento radical / Imaging diagnosis for prostate cancer biochemical recurrence after radical treatment

Los recientes desarrollos en las técnicas de diagnóstico por imagen permiten mejorar el diagnóstico de la recidiva del cáncer de próstata especialmente si la recidiva es local. A día de hoy, la resonancia magnética (RM) con técnicas morfológicas y funcionales tiene una mayor sensibilidad para el diagnóstico de la recidiva local. La integración de esta información con las biopsias guiadas por ecografía transrectal, permiten un mayor acierto diagnóstico. Sin embargo son necesarios nuevos avances que permitan establecer el diagnóstico de recidiva a distancia, para el que tenemos una escasa sensibilidad con técnicas como el TC (tomografía computarizada) o la Gammagrafía Ósea. Probablemente el PET-TC con nuevos radiofármacos (actualmente en desarrollo) pueda desempeñar en este aspecto un papel más relevante en el futuro. La integración de la información aportada por las diferentes técnicas, permitirá realizar un diagnóstico más preciso de la recidiva y establecer el tratamiento más adecuado para el paciente, reduciendo la morbilidad y permitiendo tratamientos locales más conservadores(AU)

The recent development in the imaging diagnostic techniques have improved the diagnosis of prostate cancer recurrence, mainly if it is local. Nowadays, the use of MRI based morphologic and functional techniques has a better sensitivity for the diagnosis of local recurrence. Integration of MR imaging data with ultrasound guided transrectal biopsies has improved the accuracy in the diagnosis of local recurrence of the disease. However, there is a need for new or better methods that enable the detection of secondary systemic disease, the conventional methods being (CT and bone scintigraphy) insufficiently sensitive. Nowadays the PET-CT is the most promising technique, for which the use of new radio-pharmaceuticals (on experimental phases) would allow the diagnosis of systemic disease more accurately. The combined and complimentary use of the different imaging techniques available, will permit to diagnose relapsing disease earlier and better, setting the field up for more adequate treatments, reducing morbility and giving the opportunity to offer local, less aggressive treatments(AU)

First percutaneous computed tomography-guided radiofrequency ablation of renal tumor in horseshoe kidney.

OBJECTIVE: To report the first case of percutaneous radiofrequency ablation of a tumor in a horseshoe kidney. MATERIALS AND METHODS: A 75-year-old man presented with a 3-cm solid mass on the isthmus of a horseshoe kidney. The tumor was discovered incidentally on a routine computed tomography scan performed during follow-up of a colon carcinoma treated with open hemicolectomy. The patient presented a high anesthetic risk (American Society of Anesthesiologists score of 3) because of a comorbid cardiovascular condition. Biopsy of the mass revealed type I papillary carcinoma. We performed percutaneous radiofrequency ablation using a posterior approach. RESULTS: No complications occurred, and postoperative computed tomography 3 months after the procedure showed no significant contrast enhancement in the treated area. CONCLUSIONS: To our knowledge, this is the first case of a tumor in a horseshoe kidney satisfactorily treated with percutaneous radiofrequency ablation. The technique could represent an alternative to traditional surgery in selected cases.

Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico / Descriptive study of hepatocellular carcinoma in noncirrhotic liver

Introducción y objetivoEl carcinoma hepatocelular (CHC) es la sexta causa de cáncer. En el mundo occidental su incidencia está en aumento y la gran mayoría asientan sobre una cirrosis hepática. El objetivo del estudio fue evaluar las características del CHC en pacientes sin cirrosis.MétodosSe realizó una revisión retrospectiva de 469 pacientes con diagnóstico de CHC durante el periodo de enero de 2003 a diciembre de 2007. Se seleccionaron aquellos pacientes que cumplían criterios histológicos, o la conjunción de criterios clínicos, analíticos, radiológicos y/o de hemodinámica hepática, de ausencia de cirrosis hepática.ResultadosSe identificaron 29 pacientes con diagnóstico de CHC sobre hígado no cirrótico (6,2%). El 86,2% eran varones y con una mediana de edad de 61,6 (23 - 82) años. La enfermedad hepática fue hepatopatía crónica con fibrosis leve-moderada en el 68,9%. El 62,1% de los pacientes se encontraban asintomáticos al diagnóstico. El CHC era un nódulo único en el 86,2%, y la mediana del nódulo mayor fue 46 (20 - 150) mm. Se evidenció invasión vascular macroscópica en dos pacientes y metástasis óseas en otros dos. Se realizó tratamiento activo en 25 pacientes: 15 resección quirúrgica, 6 radiofrecuencia y 4 quimioembolización transarterial. La supervivencia acumulada a 1, 2 y 3 años, fue del 84,3; 67,2 y 50,1%, respectivamente.ConclusionesEl CHC sobre hígado no cirrótico es una patología poco frecuente, siendo tumores de gran tamaño al diagnóstico. A pesar de ello, se pueden aplicar tratamientos con intención curativa y alcanzar una supervivencia superior a la esperable en pacientes con cirrosis(AU)

Introduction and objectiveHepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. Methods: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included.ResultsWe identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3years was 84.3%, 67.2% and 50.1%, respectively.ConclusionHCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis(AU)

[Descriptive study of hepatocellular carcinoma in noncirrhotic liver]. / Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico.

INTRODUCTION AND OBJECTIVE: Hepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. METHODS: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included. RESULTS: We identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3 years was 84.3%, 67.2% and 50.1%, respectively. CONCLUSION: HCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis.

Técnicas de imagen en la evaluación de las manifestaciones sistemáticas de las vasculitis / Imaging techniques for the evaluation of systemic manifestations of vasculitis

Las vasculitis provocan un proceso inflamatorio vascular que determina distintas manifestaciones orgánicas que dependen del calibre del vaso afectado y de su localización. Las técnicas de imagen desempeñan un papel importante en la caracterización y detección de las vasculitis de vasos grandes y medianos, pues son capaces de detectar el edema parietal y de monitorizar la respuesta para el tratamiento. En las vasculitis de vasos pequeños las técnicas de imagen son necesarias para estudiar las diferentes repercusiones orgánicas o sistémicas, ya que en el momento actual ninguna técnica de imagen tiene la resolución espacial suficiente para visualizarlos de forma directa (AU)

Vasculitides create a local inflammatory process in the vessel wall, which determines the different organic manifestations according to vessel size and location. Imaging techniques play a key role in the characterization and detection of large and medium size vessel vasculitides. Imaging is able to detect the vessel wall edema and to monitor the therapeutic response. In small vessel vasculitis, imaging can indirectly analyse the organic and/or systemic manifestations, because at present, none of the imaging techniques has the necessary spatial resolution to directly visualize small vessels (AU)

Estudio por imagen del hombro doloroso / Imaging studies in cases with painful shoulder

El hombro doloroso es un problema clínico frecuente en la enfermedad osteomuscular. Las pruebas de imagen desempeñan un papel importante en el diagnóstico etiológico. La radiografía convencional generalmente es la primera prueba realizada y en ocasiones es suficiente para el diagnóstico. Las calcificaciones tendinosas se ven con claridad y en el diagnóstico etiológico de las neoplasias óseas las técnicas tomográficas no la han sustituido. La patología tendinosa es la causa más frecuente de dolor en el hombro, y tanto la ecografía como la resonancia magnética (RM) son herramientas eficaces para su estudio. La RM es la técnica que mejor detecta cambios patológicos precoces. Asimismo, es fundamental en la valoración prequirúrgica del hombro y en la estadificación local de los tumores óseos y de las partes blandas (AU)

Painful shoulder is a frequent clinical problem in musculoskeletal pathology. Imaging plays an essential role in the etiologic diagnosis. Simple X-rays are usually the first performed diagnostic test, and on occasion, it is enough to establish a diagnosis. Tendinous calcifications are clearly depicted on plain radiographs, which are a first option modality in the evaluation of bone tumors. Tendinous pathology is the most common cause of shoulder pain. It may be analysed either by ultrasound or magnetic resonance (MR). MR is the most sensitive technique to detect early pathological changes. MR is usually used in the presurgical evaluation of the shoulder and in local staging of bone and soft tissue tumors (AU)

[Imaging studies in cases with painful shoulder]. / Estudio por imagen del hombro doloroso.

Painful shoulder is a frequent clinical problem in musculoskeletal pathology. Imaging plays an essential role in the etiologic diagnosis. Simple X-rays are usually the first performed diagnostic test, and on occasion, it is enough to establish a diagnosis. Tendinous calcifications are clearly depicted on plain radiographs, which are a first option modality in the evaluation of bone tumors. Tendinous pathology is the most common cause of shoulder pain. It may be analysed either by ultrasound or magnetic resonance (MR). MR is the most sensitive technique to detect early pathological changes. MR is usually used in the presurgical evaluation of the shoulder and in local staging of bone and soft tissue tumors.

[Imaging techniques for the evaluation of systemic manifestations of vasculitis]. / Técnicas de imagen en la evaluación de las manifestaciones sistemáticas de las vasculitis.

Vasculitides create a local inflammatory process in the vessel wall, which determines the different organic manifestations according to vessel size and location. Imaging techniques play a key role in the characterization and detection of large and medium size vessel vasculitides. Imaging is able to detect the vessel wall edema and to monitor the therapeutic response. In small vessel vasculitis, imaging can indirectly analyse the organic and/or systemic manifestations, because at present, none of the imaging techniques has the necessary spatial resolution to directly visualize small vessels.