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1.
Medicine (Baltimore) ; 98(40): e16912, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577696

RESUMO

INTRODUCTION: Accessory liver lobe (ALL) is a rare congenital anomaly. ALL combined with hepatocellular carcinoma (HCC) is even rarer. Most ALLs with HCC are often located in the right liver, and are not supplied by the left hepatic artery. PATIENT CONCERNS: A 77-year-old man was referred to our hospital because of the level of serum alpha-fetoprotein (AFP) continually increased for 1 month. He had no history of chronic hepatitis, alcohol abuse, or cirrhosis of the liver. DIAGNOSES: Preoperative computed tomography (CT) scan revealed a 3.0 × 3.0 × 1.0 cm ovaloid-shaped solid mass in the left subphrenic area with isodensity. Magnetic resonance imaging (MRI) showed a mass with a heterogeneous signal on T1- and T2-weighted images. On contrast-enhanced CT and MRI, the mass showed a pattern of early enhancement and washout. Digital subtraction angiography (DSA) confirmed the mass was fed by the branch of left liver artery. INTERVENTIONS: The mass was treated by transatheter arterial embolization (TAE) followed by surgical resection. Histopathologically showed HCC, consistent with a moderately differentiated. OUTCOMES: Follow-up of 3 months after surgery, the level of AFP returned to normal gradually. CONCLUSIONS: In this report, we describe a rare case of ALL with HCC, located in the left subphrenic area, especially which was supplied by the branch of left hepatic artery has rarely been described. The clinical presentation, radiological features are described in the literature.


Assuntos
Carcinoma Hepatocelular/patologia , Artéria Hepática/patologia , Neoplasias Hepáticas/patologia , Fígado/anormalidades , Fígado/patologia , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Embolização Terapêutica , Artéria Hepática/diagnóstico por imagem , Humanos , Fígado/efeitos dos fármacos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
3.
Zhonghua Wai Ke Za Zhi ; 57(8): 578-584, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31422626

RESUMO

Objective: To study the application value of augmented-reality (AR) surgical navigation technology combined with indocyanine green (ICG) molecular fluorescence imaging in three-dimensional (3D) laparoscopic hepatectomy. Methods: The clinical data of forty-eight patients who had undergone 3D laparoscopic hepatectomy for hepatocellular carcinoma at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from January 2018 to April 2019 were retrospectively analyzed.The patients were divided into two groups: the group of 3D laparoscopic hepatectomy navigated by augment reality technology combined with ICG molecular fluorescence imaging (Group A) , and group of conventional 3D laparoscopic hepatectomy (Group B) . Patients in Group A (n=23) underwent 3D laparoscopic hepatectomy using augmented-reality technology combined with ICG molecular fluorescence imaging. In this group, the self-developed three-dimensional laparoscopic augmented-reality surgical navigation system (No. 2018SR840555) was operated to project the preoperative three-dimensional model to the surgical field, and the use of this system in combination with ICG molecular fluorescence imaging navigated laparoscopic hepatectomy. No surgical navigation technology was applied in Group B (n=25) . All patients signed the informed consent, which were in accordance with the requirements of medical ethics (Ethics No.: 2018-GDYK-003) . The preoperative data, surgical indicators and postoperative complications between the two groups were compared and analyzed. Results: The median amount of intraoperative blood loss of Group A was 250 (200) ml (M (Q(R)) ) , which was significantly lower than that of Group B (300 (150) ml) (Z=-2.307, P=0.021) .The transfusion rate of Group A was 13.0% (3/23) , which was significantly lower than that of Group B (40.0%, 10/25) (χ(2)=4.408, P=0.036) .The median postoperative hospitalization time of Group A was 8 (2) d, which was significantly shorter than that of Group B (11 (6.5) d) (Z=-2.694, P=0.007) . There were no serious complications and perioperative death in both groups.The incidence of postoperative complications in Group A was 17.4% (4/23) , which was not significantly different from that in group B (28%, 7/25) (χ(2)=0.763, P=0.382) . Conclusion: Augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging has better effect in 3D laparoscopic hepatectomy.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Carcinoma Hepatocelular/diagnóstico por imagem , Corantes Fluorescentes , Humanos , Imagem Tridimensional , Verde de Indocianina , Laparoscopia , Neoplasias Hepáticas/diagnóstico por imagem , Estudos Retrospectivos , Técnicas Estereotáxicas , Cirurgia Assistida por Computador
4.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(4): 581-589, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31441258

RESUMO

In order to solve the pathological grading of hepatocellular carcinomas (HCC) which depends on biopsy or surgical pathology invasively, a quantitative analysis method based on radiomics signature was proposed for pathological grading of HCC in non-contrast magnetic resonance imaging (MRI) images. The MRI images were integrated to predict clinical outcomes using 328 radiomics features, quantifying tumour image intensity, shape and text, which are extracted from lesion by manual segmentation. Least absolute shrinkage and selection operator (LASSO) were used to select the most-predictive radiomics features for the pathological grading. A radiomics signature, a clinical model, and a combined model were built. The association between the radiomics signature and HCC grading was explored. This quantitative analysis method was validated in 170 consecutive patients (training dataset: n = 125; validation dataset, n = 45), and cross-validation with receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (AUC) was employed as the prediction metric. Through the proposed method, AUC was 0.909 in training dataset and 0.800 in validation dataset, respectively. Overall, the prediction performances by radiomics features showed statistically significant correlations with pathological grading. The results showed that radiomics signature was developed to be a significant predictor for HCC pathological grading, which may serve as a noninvasive complementary tool for clinical doctors in determining the prognosis and therapeutic strategy for HCC.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Gradação de Tumores/métodos , Humanos , Imagem por Ressonância Magnética , Curva ROC
5.
Ultraschall Med ; 40(4): 404-424, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31382313

RESUMO

Contrast-enhanced ultrasound (CEUS) has a high diagnostic accuracy in the assessment of focal liver lesions. Clinical context (presence of liver cirrhosis, history of other malignancy versus incidental finding) is crucial for the correct interpretation of CEUS findings. CEUS has to be preceded by structured anamnesis and clinical examination as well as accurate B-mode sonography. Metastases are the most common malignant liver lesions in a non-cirrhotic liver. According to their contrast enhancement in the arterial phase, metastases are categorized as hyper- and hypo-vascular metastases. A common feature of all metastatic lesions is washout of the contrast agent in the portal venous or late phase. In the context of liver cirrhosis, > 95 % of focal liver lesions are hepatocellular carcinomas (HCCs). HCCs typically show arterial phase hyperenhancement, followed by mild and gradual contrast washout occurring very late in the late phase. For intrahepatic cholangiocellular carcinoma (ICC), the pattern of contrast enhancement in the arterial phase can vary. However, all ICCs typically show early and pronounced washout. Other liver malignancies like lymphoma, angiosarcoma, epithelioid hemangioendothelioma and others are very rare. Except for the contrast washout seen in all liver malignancies, they do not display pathognomonic enhancement patterns upon CEUS. Thus, biopsy is indispensable for definite diagnosis of the tumor entity. Furthermore, CEUS is used for the detection of metastases and therapeutic monitoring after local ablative procedures. The examination procedure differs slightly depending on the specific indication (characterization, detection).


Assuntos
Carcinoma Hepatocelular , Meios de Contraste , Neoplasias Hepáticas , Ultrassonografia , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Ultrassonografia/métodos
6.
Anticancer Res ; 39(8): 4219-4225, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366509

RESUMO

BACKGROUND/AIM: The aim of the study was to evaluate surgical outcomes of patients with high-signal intensity (SI) image hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Between 2008 and 2013, 257 HCC patients were retrospectively evaluated. A total of 21 patients were diagnosed as high-SI image HCC, 215 as low-SI image HCC, and 21 patients as mixed (high and low)-SI image HCC in the hepatobiliary (HB) phase of MRI. Five-year overall survival (OS) and recurrence-free survival (RFS) were compared among patient groups. RESULTS: The 5-year OS and RFS rates were significantly higher in patients with high-SI image HCC (100% and 56%) than in patients with low-SI image HCC (71%; p=0.097 and 38%; p=0.0209) and in patients with mixed-SI image HCC (73%; p=0.0329 and 9%; p=0.0021). High-SI image was an independent prognostic factor for OS (relative risk 0.167, p=0.0178) and RFS (relative risk 0.471, p=0.0322) on multivariate analysis. CONCLUSION: Patients with high-SI image HCC showed favorable long-term survival after curative surgery.


Assuntos
Sistema Biliar/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Sistema Biliar/patologia , Carcinoma Hepatocelular/patologia , Meios de Contraste/administração & dosagem , Intervalo Livre de Doença , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Neoplasias Hepáticas/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos
7.
Cancer Radiother ; 23(6-7): 636-650, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31444078

RESUMO

Liver stereotactic body radiotherapy is a developing technique for the treatment of primary tumours and metastases. Its implementation is complex because of the particularities of the treated organ and the comorbidities of the patients. However, this technique is a treatment opportunity for patients otherwise in therapeutic impasse. The scientific evidence of liver stereotactic body radiotherapy has been considered by the French health authority as insufficient for its widespread use outside specialized and experienced centers, despite a growing and important number of retrospective and prospective studies, but few comparative data. This article focuses on the specific features of stereotactic body radiotherapy for liver treatments and the results of published studies of liver stereotactic body radiotherapy performed with classic linear accelerators and dedicated radiosurgery units.


Assuntos
Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Radiocirurgia/instrumentação , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Fígado/efeitos da radiação , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Movimentos dos Órgãos , Aceleradores de Partículas , Guias de Prática Clínica como Assunto , Tolerância a Radiação , Radiocirurgia/métodos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Respiração , Resultado do Tratamento
8.
Radiol Med ; 124(10): 1043-1048, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31270723

RESUMO

AIM: Evaluating clinical and technical factors affecting thermal ablation of B-Mode/CEUS inconspicuous HCC nodules, relying only on fusion imaging (FI) performed under conscious sedation and using previously acquired CT or MR. MATERIALS AND METHODS: Among 367 HCC nodules treated in the study period, data of 37 B-mode/CEUS undetectable HCC nodules treated with FI-guided ablation were extracted from our prospectively collected institutional database. Analyzed variables included patients' sex, age, cirrhosis etiology, Child-Pugh status, size of the lesion, liver segment, subcapsular or central liver site, type of imaging used for fusion (MR/CT), and the presence of surrounding anatomical landmarks (SAL) < 3 cm from the index lesion. RESULTS: The primary efficacy was 59.4% (22/37 nodules); nine lesions (24.3%) were partially ablated (PA), six lesions (16.7%) were mistargeted (MA). Eight nodules were retreated with a CA obtained in all cases (100% CA, secondary efficacy in 30/37-81.1%). LTP was observed in 2/30 cases (6.7%). Two minor complications were registered (Clavien-Dindo, Grade1, CIRSE Classification Grade 2). SAL were related to a better ablation outcome (37.5% vs 84.6% p = 0.01). No differences were observed between CA group and PA-MA group in terms of lesion size (15.4 mm vs 14.9 mm p = 0.63), liver segment (p = 0.58), subcapsular or central liver site (8/22 36% vs 4/15 26.7% p = 0.84), and imaging (MR vs CT, p = 0.72). CONCLUSION: Even in the presence of potentially critical conditions (completely B-Mode/CEUS inconspicuous nodules, spontaneous breathing, and previously acquired CT or MRI), FI-only guidance is safe and allows having good primary, secondary efficacy and LTP rates. The outcome of the procedure is heavily affected by the presence of SAL.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Imagem Multimodal , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Carcinoma Hepatocelular/patologia , Sedação Consciente , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Neoplasias Hepáticas/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Estudos Prospectivos , Hexafluoreto de Enxofre , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Clin Nucl Med ; 44(9): 702-706, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31348076

RESUMO

Prostate specific membrane antigen (PSMA) expression has been demonstrated in tumor neovasculature of many solid tumors, including hepatocellular carcinoma (HCC). The purpose of this study is to evaluate PSMA expression in patients with HCC. MATERIALS AND METHODS: Nineteen HCC patients who underwent F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) as part of restaging procedure also underwent Ga-PSMA PET. F-FDG PET and Ga-PSMA findings were compared visually as well as quantitatively using maximized standardized uptake values (SUVmax). RESULTS: FDG was positive in 15 patients while 16 patients demonstrated PSMA expression. The only extrahepatic finding was one metastatic lymph node detected by both tracers. Mean SUVmax of liver lesions on FDG PET/CT was 8.3 ± 2.3 and mean tumor to background ratio was 2.3 ± 1.5. Respective values for Ga-PSMA PET/CT were 17.4 ± 9 and 3.3 ± 2.2. On visual and quantitative evaluation uptake was higher with PSMA in nine patients and higher with FDG in four patients. PSMA and FDG activity were similar in three patients. One of the FDG positive patients was PSMA negative whereas two patients were PSMA positive but FDG negative. Heterogeneous uptake pattern was observed in three patients. Comparison of mean SUVmax and T/B values between PET studies revealed no statistically significant difference (P > 0.1). The mean survival was 25 months (range: 18-32 months) and SUVmax of PSMA (P = 0.05) and FDG (P = 0.012) showed medium strength of correlation with overall survival. CONCLUSION: PSMA expression in advanced HCC can be demonstrated by Ga-PSMA PET but is not superior to FDG PET however it could be useful for identifying patients with limited therapeutic options.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/metabolismo , Regulação Neoplásica da Expressão Gênica , Glutamato Carboxipeptidase II/metabolismo , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Ácido Edético/análogos & derivados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oligopeptídeos
10.
Br J Radiol ; 92(1100): 20190067, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31192695

RESUMO

OBJECTIVE: The purpose of this work is to develop and validate a learning-based method to derive electron density from routine anatomical MRI for potential MRI-based SBRT treatment planning. METHODS: We proposed to integrate dense block into cycle generative adversarial network (GAN) to effectively capture the relationship between the CT and MRI for CT synthesis. A cohort of 21 patients with co-registered CT and MR pairs were used to evaluate our proposed method by the leave-one-out cross-validation. Mean absolute error, peak signal-to-noise ratio and normalized cross-correlation were used to quantify the imaging differences between the synthetic CT (sCT) and CT. The accuracy of Hounsfield unit (HU) values in sCT for dose calculation was evaluated by comparing the dose distribution in sCT-based and CT-based treatment planning. Clinically relevant dose-volume histogram metrics were then extracted from the sCT-based and CT-based plans for quantitative comparison. RESULTS: The mean absolute error, peak signal-to-noise ratio and normalized cross-correlation of the sCT were 72.87 ± 18.16 HU, 22.65 ± 3.63 dB and 0.92 ± 0.04, respectively. No significant differences were observed in the majority of the planning target volume and organ at risk dose-volume histogram metrics ( p > 0.05). The average pass rate of γ analysis was over 99% with 1%/1 mm acceptance criteria on the coronal plane that intersects with isocenter. CONCLUSION: The image similarity and dosimetric agreement between sCT and original CT warrant further development of an MRI-only workflow for liver stereotactic body radiation therapy. ADVANCES IN KNOWLEDGE: This work is the first deep-learning-based approach to generating abdominal sCT through dense-cycle-GAN. This method can successfully generate the small bony structures such as the rib bones and is able to predict the HU values for dose calculation with comparable accuracy to reference CT images.


Assuntos
Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Imagem por Ressonância Magnética/métodos , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Carcinoma Hepatocelular/diagnóstico por imagem , Aprendizado Profundo , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Radioterapia de Intensidade Modulada/métodos
11.
Gastroenterology ; 157(3): 807-822, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31194980

RESUMO

BACKGROUND & AIMS: In one-third of hepatocellular carcinomas (HCCs), cancer cells have mutations that activate ß-catenin pathway. These cells have alterations in glutamine, bile, and lipid metabolism. We investigated whether positron emission tomography (PET) imaging allows identification of altered metabolic pathways that might be targeted therapeutically. METHODS: We studied mice with activation of ß-catenin in liver (Apcko-liv mice) and male C57Bl/6 mice given injections of diethylnitrosamine, which each develop HCCs. Mice were fed a conventional or a methionine- and choline-deficient diet or a choline-deficient (CD) diet. Choline uptake and metabolism in HCCs were analyzed by micro-PET imaging of mice; livers were collected and analyzed by histologic, metabolomic, messenger RNA quantification, and RNA-sequencing analyses. Fifty-two patients with HCC underwent PET imaging with 18F-fluorodeoxyglucose, followed by 18F-fluorocholine tracer metabolites. Human HCC specimens were analyzed by immunohistochemistry, quantitative polymerase chain reaction, and DNA sequencing. We used hepatocytes and mouse tumor explants for studies of incorporation of radiolabeled choline into phospholipids and its contribution to DNA methylation. We analyzed HCC progression in mice fed a CD diet. RESULTS: Livers and tumors from Apcko-liv mice had increased uptake of dietary choline, which contributes to phospholipid formation and DNA methylation in hepatocytes. In patients and in mice, HCCs with activated ß-catenin were positive in 18F-fluorocholine PET, but not 18F-fluorodeoxyglucose PET, and they overexpressed the choline transporter organic cation transporter 3. The HCC cells from Apcko-liv mice incorporated radiolabeled methyl groups of choline into phospholipids and DNA. In Apcko-liv mice, the methionine- and choline-deficient diet reduced proliferation and DNA hypermethylation of hepatocytes and HCC cells, and the CD diet reduced long-term progression of tumors. CONCLUSIONS: In mice and humans, HCCs with mutations that activate ß-catenin are characterized by increased uptake of a fluorocholine tracer, but not 18F-fluorodeoxyglucose, revealed by PET. The increased uptake of choline by HCCs promotes phospholipid formation, DNA hypermethylation, and hepatocyte proliferation. In mice, the CD diet reverses these effects and promotes regression of HCCs that overexpress ß-catenin.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/genética , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/genética , Mutação , Tomografia por Emissão de Pósitrons , beta Catenina/genética , Animais , Carcinoma Hepatocelular/induzido quimicamente , Carcinoma Hepatocelular/patologia , Proliferação de Células , Colina/administração & dosagem , Colina/análogos & derivados , Deficiência de Colina/complicações , Metilação de DNA , Dietilnitrosamina , Modelos Animais de Doenças , Genes APC , Predisposição Genética para Doença , Humanos , Neoplasias Hepáticas/induzido quimicamente , Neoplasias Hepáticas/patologia , Masculino , Metionina/deficiência , Camundongos Endogâmicos C57BL , Camundongos Knockout , Fenótipo , Fosfolipídeos/metabolismo , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/administração & dosagem , beta Catenina/metabolismo
12.
Br J Radiol ; 92(1099): 20190073, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31166700

RESUMO

OBJECTIVES: To evaluate the value of preoperative MRI features and laboratory indicators in predicting the early response of hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization (TACE) combined with high-intensity focused ultrasound (HIFU) treatment and to establish a preoperative prediction model. METHODS: A total of 188 patients with 223 tumors who underwent TACE/HIFU treatment from January 2011 to June 2017 were included. Tumors were divided into three groups (< 2 cm, 2 - 5 cm,> 5 cm) and classified as non-complete response (NCR) and complete response (CR) cohorts according to the Response Evaluation Criteria in Cancer of the Liver (RECICL) 2015 revised version. Univariate analysis and multivariate logistic regression analysis were used to determine independent predictors, and receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic power of each predictor. The prediction model was derived on the ß coefficient of the multivariate regression analysis of the predictors. RESULTS: Irregular margins in the 2 - 5 cm group were closely related to early NCR. Irregular margins, arterial peritumoral enhancement and abnormal alpha-fetoprotein (AFP) were independent predictors of early NCR in the > 5 cm group. The prediction model of this group suggests that irregular margins combined with arterial peritumoral enhancement and abnormal AFP combined with irregular margins and arterial peritumoral enhancement predict an increased risk of early NCR. CONCLUSION: Irregular margins of 2 - 5 cm tumors and irregular margins, arterial peritumoral enhancement, and abnormal AFP of tumors > 5 cm can be applied to predict the early response of HCC to TACE/HIFU treatment. ADVANCES IN KNOWLEDGE: TACE combined with HIFU treatment may be able to significantly improve survival in patients with advanced HCC. Conventional MRI features and laboratory indicators are readily available without complex post-processing. It is feasible to predict the response of HCC after TACE/HIFU treatment based on preoperative conventional MRI features and laboratory indicators, the combination of multiple features predicts high-risk of non-complete response.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Neoplasias Hepáticas/terapia , Imagem por Ressonância Magnética/métodos , Cuidados Pré-Operatórios/métodos , Adulto , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
Eur J Radiol ; 116: 41-46, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153572

RESUMO

OBJECTIVE: To describe the liver imaging findings of Hereditary tyrosinemia type-1 (HT1) patients. MATERIALS AND METHODS: We report 16 patients (8 Female and 8 Male) with HT-1. Their demographic features, imaging findings and alpha feto protein (AFP) levels were recorded. Imaging features on CT and MR were evaluated for the following characteristics: contour of the liver and liver nodules. Liver nodules were categorized as; regenerative, dysplastic, fatty and malignant nodules (HCC). RESULTS: Thirteen (81%) patients had multiple liver nodules (>20) on imaging studies. Five patients (31%) had regenerative nodules, six (38%) had dysplastic nodules and ten (63%) had fatty nodules. Dysplastic nodules were encountered in two patients with HCC and in four patients without a tumor. Four patients (25%) had HCC nodule on imaging studies. Those four patients had biopsy and all of them had HCC nodule on histopathology. In the follow-up period, in one patient fatty nodules had increased in size, in one patient regenerative nodules had disappeared and in one patient dysplastic nodules had disappeared. CONCLUSIONS: Multiple fatty nodules can be seen in HT1 patients and in some patients, the regenerative and dysplastic nodules can disappear during the follow-up period.


Assuntos
Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tirosinemias/complicações , Carcinoma Hepatocelular/patologia , Pré-Escolar , Diagnóstico Diferencial , Feminino , Hospitais Pediátricos , Humanos , Lactente , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/patologia , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária
14.
Oncology ; 97(2): 75-81, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31242488

RESUMO

AIM: This study investigated early tumor marker response and treatment response in patients with advanced hepatocellular carcinoma (HCC) treated with lenvatinib. METHODS: Twenty patients with advanced HCC who received lenvatinib were enrolled in this retrospective study. α-Fetoprotein (AFP) and des-γ-carboxyprothrombin (DCP) levels were measured before treatment as well as 2 and 4 weeks after treatment. The objective response rate was evaluated by mRECIST at 6 weeks. RESULTS: The response rate was 30% (complete response/partial response/stable disease/progressive disease: n = 0/6/6/8 cases) by mRECIST. At 4 weeks, the AFP levels of 12 patients (80%) were lower than at baseline. The AFP levels of 9 patients (60%) continued decreasing from 2 weeks to 4 weeks (sustained-reduction group). In this group, the response rate was 67%. The median AFP change rate was -39% at 4 weeks. In imaging responders, the AFP change rate significantly decreased (p = 0.02). The DCP change rate had no significant correlation with imaging response. The AFP-sustained-reduction group had significantly higher adherence to lenvatinib than the non-sustained-reduction group (p = 0.02). CONCLUSION: With lenvatinib therapy for HCC, the AFP levels of most patients had declined at 2 weeks, and at 4 weeks the AFP-sustained-reduction group demonstrated a higher objective response.


Assuntos
Antineoplásicos/uso terapêutico , Biomarcadores Tumorais/metabolismo , Biomarcadores/metabolismo , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Compostos de Fenilureia/uso terapêutico , Precursores de Proteínas/metabolismo , Protrombina/metabolismo , Quinolinas/uso terapêutico , alfa-Fetoproteínas/metabolismo , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/metabolismo , Quimioembolização Terapêutica , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
Med Sci Monit ; 25: 3406-3416, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31067211

RESUMO

BACKGROUND This study aimed to compare the application value of intraoperative fluorescence navigation technology (FNT) and intraoperative ultrasound (IOUS) in primary liver cancer surgery. MATERIAL AND METHODS Fifty consecutive patients with primary liver cancer scheduled to receive surgical treatment were divided into FNT group and IOUS group. FNT and IOUS were separately used to guide tumor resection and detect new cancerous lesions in the 2 groups. The complete tumor resection rate (R0) resection rate, length of the tumor distance from cutting edge, the diagnostic efficacy of cancerous nodules and the fluorescence imaging characteristics of different types tumors were recorded. RESULTS The R0 resection rate was 100% (25 out of 25 patients) in the FNT group and 96% (24 out of 25 patients) in the IOUS group. In the FNT group, 1 case (4%, 1 out of 25 patients) had cancer tissue that was less than 1 cm from the cutting edge, compared to 7 cases (28%, 7 out of 25 patients) in the IOUS group (P=0.049), which was a significant difference. In the remaining livers of 50 consecutive patients, FNT found 5 new cancerous nodules with a sensitivity of 71.4%, a specificity of 11.1%, and a false-positive rate of 88.9%; for IOUS the results were 42.9%, 88.9%, 11.1%. The fluorescence imaging characteristics of all well-differentiated hepatocellular carcinomas were tumor tissue imaging, but all other types of tumors were ring imaging around the tumor. CONCLUSIONS FNT can improve the R0 resection rate, ensure a safe distance between tumor and cutting edge and can identify more new cancerous nodules compared to IOUS. Thus, FNT could improve the surgical treatment effect for primary liver cancer and hopefully further improve the prognosis of patients.


Assuntos
Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Monitorização Intraoperatória/métodos , Adulto , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/cirurgia , Meios de Contraste , Feminino , Fluorescência , Hepatectomia/métodos , Humanos , Verde de Indocianina , Cuidados Intraoperatórios , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Ultrassonografia de Intervenção/métodos
16.
Tech Vasc Interv Radiol ; 22(2): 100-111, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079706

RESUMO

Transarterial radioembolization (TARE) with beta particle emitting microspheres via Yttrium-90 decay has become a fundamental component of the contemporary Interventional Oncology practice. TARE continues to advance as a result of increased utilization, clinical study, technological improvements, and evolving applications. To maximize TARE safety and efficacy, a core understanding of dosimetry is essential. The intent of this overview is to provide the reader with a general survey of radiation physics and biology, device differentiation, patient selection, anatomic assessment, activity administration models, and procedural techniques involved with TARE dosimetry.


Assuntos
Carcinoma Hepatocelular/radioterapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Lesões por Radiação/prevenção & controle , Radiobiologia/normas , Radiologia Intervencionista , Radioisótopos de Ítrio/uso terapêutico , Braquiterapia/métodos , Carcinoma Hepatocelular/diagnóstico por imagem , Quimioembolização Terapêutica/métodos , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Microesferas , Especificidade de Órgãos , Seleção de Pacientes , Lesões por Radiação/etiologia
17.
Tech Vasc Interv Radiol ; 22(2): 42-48, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079709

RESUMO

The frequency of transradial access in interventional radiology has been steadily increasing, including for yttrium-90 (Y-90) selective internal radiation therapy to treat hepatic malignancies. The aim of this article is to detail an optimized approach to transradial Y-90 (TRY-90), showing it to be a safe and feasible first-line approach to hepatic selective internal radiation therapy. Salient preprocedural considerations to enable appropriate patient selection for TRY-90 are discussed and a detailed equipment list is provided. The article will describe our approach to TRY-90 in addition to a discussion around technical pearls and pitfalls.


Assuntos
Carcinoma Hepatocelular/radioterapia , Cateterismo Periférico/instrumentação , Neoplasias Hepáticas/radioterapia , Artéria Radial , Radiografia Intervencionista , Radioisótopos de Ítrio/uso terapêutico , Carcinoma Hepatocelular/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Seleção de Pacientes
18.
Tech Vasc Interv Radiol ; 22(2): 49-57, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079710

RESUMO

The radiation segmentectomy technique may be defined as the administration of transarterial radioembolization delivered to 1 or 2 hepatic segments with the intention of segmental tissue ablation. Since first being described in 2011, radiation segmentectomy has quickly gained acceptance as a safe, effective, and potentially curative outpatient treatment for selected lower stage hepatocellular carcinomas. We describe our recommended techniques for radiation segmentectomy with glass or resin radiomicrospheres, including patient selection, dosimetry, microcatheter techniques, and clinical and imaging follow-up, accompanied by a brief review of the radiation segmentectomy literature. Radiation lobectomy, defined as the ablation of an entire hepatic lobe via transarterial radioembolization, is an area of growing interest in many centers. We also review the existing radiation lobectomy literature and suggest which patient and tumor factors may be associated with higher likelihood of successful treatment.


Assuntos
Carcinoma Hepatocelular/radioterapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Radiografia Intervencionista/métodos , Radioisótopos de Ítrio/uso terapêutico , Carcinoma Hepatocelular/diagnóstico por imagem , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Microesferas , Seleção de Pacientes , Dosagem Radioterapêutica
19.
Tech Vasc Interv Radiol ; 22(2): 70-73, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079713

RESUMO

Y90 radioembolization is an alternative to transarterial chemoembolization for the intra-arterial treatment of hepatocellular carcinoma (HCC). However, the optimal treatment of HCC varies by tumor stage, underlying liver function and functional status, and local expertise. Therefore, the appropriate selection of patients for Y90 radioembolization is of paramount importance for optimal outcomes. Data on the role of Y90 radioembolization for HCC are most robust in the palliative treatment of inoperable, liver-confined disease. However, data are also present on the role of Y90 radioembolization as a bridge to or to downstage patients for transplant. Outcomes for radiation segmentectomy (ablative radiation doses) with curative intent or prior to resection are also discussed.


Assuntos
Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Avaliação de Processos e Resultados (Cuidados de Saúde) , Seleção de Pacientes , Radiografia Intervencionista/métodos , Radioisótopos de Ítrio/uso terapêutico , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Testes de Função Hepática , Neoplasias Hepáticas/diagnóstico por imagem , Transplante de Fígado , Pulmão/efeitos da radiação , Dosagem Radioterapêutica
20.
Tech Vasc Interv Radiol ; 22(2): 93-99, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079717

RESUMO

Radioembolization with Yttrium-90 (Y90) has been proven safe and effective for the treatment of primary and secondary hepatic malignancies. Standard protocols have necessitated planning angiography with Technetium-99m macroaggregated albumin (Tc99m MAA) administration/scan typically 1-2 weeks prior to the radioembolization therapy. The intent of this practice is to ensure appropriate patient selection and treatment candidacy while also confirming best dosimetry approaches. At our center, we started performing "same-day Y90" in 2008; in a subset of international patients with travel hardship, we performed the planning and treatment procedures consecutively on the same day. In this article, we reveal our practical approach to treating patients on the same day as planning angiography. With more than 160 same-day procedures completed between 2008 and 2017, the safety and efficacy of such a paradigm has been established at our center. This approach is appealing to patients, their families, and referring physicians. Appropriate patient selection and proper preprocedure planning based on baseline imaging are key elements in successful same-day radioembolization treatments.


Assuntos
Assistência Ambulatorial/métodos , Carcinoma Hepatocelular/radioterapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Radioisótopos de Ítrio/uso terapêutico , Idoso , Angiografia/métodos , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Humanos , Imagem Tridimensional , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Microesferas , Seleção de Pacientes , Compostos Radiofarmacêuticos/administração & dosagem , Dosagem Radioterapêutica , Agregado de Albumina Marcado com Tecnécio Tc 99m/administração & dosagem , Resultado do Tratamento
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