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1.
Anticancer Res ; 41(9): 4411-4416, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475062

RESUMO

BACKGROUND/AIM: Detection of hepatocellular carcinoma using intraoperative ultrasonography (IOUS) is indispensable for successful laparoscopic hepatectomy (LH). This study was performed to evaluate patients with intraoperatively unidentified tumours undergoing LH. PATIENTS AND METHODS: Seven patients who underwent LH for hepatocellular carcinoma and whose tumours were not detected using IOUS were included in this study. Clinical features, preoperative imaging, intraoperative imaging, surgical procedures, and pathological findings were evaluated. RESULTS: Using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, all the tumours were enhanced in the arterial phase and rapidly washed out, becoming hypointense to the remainder of the liver. All tumours except one were <2 cm in size. Severe liver fibrosis was observed in all cases. Tumours that were invisible on preoperative ultrasonography also could not be detected using IOUS or indocyanine green fluorescence imaging. Five patients underwent hepatectomy based on anatomical landmarks and achieved curative resection, whereas curative resection failed in two patients. CONCLUSION: When tumours cannot be identified by IOUS, LH based on anatomical landmarks should be preferred. Importantly, invisible tumours on preoperative ultrasonography may not be identified intraoperatively during LH.


Assuntos
Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Cirrose Hepática/patologia , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Gadolínio DTPA/administração & dosagem , Hepatectomia , Humanos , Verde de Indocianina/administração & dosagem , Laparoscopia , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Imagem por Ressonância Magnética Intervencionista , Masculino , Pessoa de Meia-Idade , Carga Tumoral , Ultrassonografia de Intervenção
2.
Chirurgia (Bucur) ; 116(4): 399-408, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34498561

RESUMO

With all the technological progress registered so far, hepatocellular carcinoma is still a diagnostic and therapeutic challenge, the optimal management being ensured only by a personalized attitude, offered by a multidisciplinary approach. Ultrasound plays an essential role in the guidelines for this neoplasm, the intraoperative application being mandatory to increase the survival of these patients, when the surgical approach is possible and indicated. This paper highlights the main indications for intraoperative ultrasound in the diagnosis and treatment of hepatocellular carcinoma, along with areas that have developmental potential.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Resultado do Tratamento , Ultrassonografia
3.
Rev Med Chil ; 149(4): 635-640, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-34479353

RESUMO

Hepatocellular carcinoma (HCC) rupture is a rare complication, with a higher prevalence in countries of Asia and Europe. Its clinical manifestations can be nonspecific, from abdominal pain and bloating to hemodynamic involvement. We report a 70-year-old male patient with a history of chronic liver disease, presenting with an enlargement and ecchymosis of the scrotum, associated with abdominal bloating. The initial abdominal ultrasound study showed increased liquid content in the scrotal sac and regional edema. A CT of the abdomen and pelvis showed a liver mass with characteristics of hepatocellular carcinoma, associated with extensive hemoperitoneum that drained into the scrotal sac. The patient was treated with embolization of the right hepatic artery and later with surgical resection of the tumor mass, with a good clinical evolution.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Hematocele , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Humanos , Neoplasias Hepáticas/complicações , Masculino , Ruptura Espontânea/diagnóstico por imagem
4.
Medicina (Kaunas) ; 57(8)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34441056

RESUMO

Hepatocellular carcinoma (HCC) typically presents in patients with a chronic liver disease and rarely develops in healthy liver, especially within an accessory liver lobe. We present a case of a healthy 64-years-old woman who showed a serum alpha-fetoprotein (AFP) value of 226.3 µg/mL during a screening blood test. Past medical history was negative for chronic liver disease or cirrhosis. Intraoperative finding was an ovaloid mass connected with the second hepatic segment by a thin pedicle of hepatic tissue. Lesion was safely resected by laparoscopic approach. Histopathology analysis showed a trabecular hepatocellular carcinoma. After a 6-month follow up, there was no evidence of recurrent disease. This case report showed how serum AFP remains a highly sensitive marker, although the presentation of HCC was unusual. To our knowledge, this is the second case reported in the literature.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Biomarcadores Tumorais , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico , Pessoa de Meia-Idade , alfa-Fetoproteínas
5.
Zhonghua Gan Zang Bing Za Zhi ; 29(7): 690-695, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34371541

RESUMO

Objective: To investigate the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation (RFA) for caudate lobe hepatocellular carcinoma (HCC) and the failure factors of incomplete tumor ablation. Methods: Twenty-four cases with caudate lobe hepatocellular carcinoma who underwent ultrasound-guided percutaneous RFA in the Affiliated Tumor Hospital of Zhengzhou University from January 2017 to October 2019 were enrolled. The ablation effect and complications conditions were recorded, and the primary technical effectiveness and local tumor progression (LTP) were evaluated. Results: Among 24 cases, 20 cases had complete ablation at one session, 4 cases had incomplete ablation, and after supplementary radiofrequency ablation all cases had achieved complete ablation. There was no evidence of local tumor progression in 24 cases after one-month postoperative evaluation. The primary technical effectiveness rate was 100%. The postoperative follow-up was 2 to 29 months (median follow-up time was 18 months). Of the 24 cases after ablation, LTP were detected in 11 cases, of which only 3 cases had distant intrahepatic recurrence, 1 case had distant intrahepatic recurrence and distant metastasis, and 5 cases had only distant metastasis, 2 cases died, and 4 cases had SIR grade B complications related to ablation. Conclusion: Ultrasound-guided percutaneous radiofrequency ablation was safe and effective for caudate lobe hepatocellular carcinoma. In addition, the distance between the tumor and the inferior vena cava < 0.5cm is a suspected risk factor for incomplete ablation of caudate lobe hepatocellular carcinoma (P < 0.05).


Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Neoplasias Hepáticas , Ablação por Radiofrequência , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção
6.
AJR Am J Roentgenol ; 217(3): 644-650, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34259543

RESUMO

OBJECTIVE. The purpose of the study is to evaluate the outcomes of ultrasound (US) LI-RADS category US-3 observations detected at US performed for hepatocellular carcinoma (HCC) screening and surveillance on the basis of subsequently performed multi-phase MRI or CT or histopathology. MATERIALS AND METHODS. In this retrospective analysis, 267 patients at high risk for HCC (161 men and 106 women; mean [± SD] age, 58.6 ± 12.2 years) underwent screening liver US between January 2017 and June 2019 and were assigned US-3 observations on a prospective clinical basis using the US LI-RADS algorithm. The results of follow-up imaging studies and/or histopathology were analyzed. RESULTS. Visualization scores assigned at US were A (40.8% [109/267]), B (52.8% [141/267]), and C (6.4% [17/267]). Reasons for US-3 observations included a measurable mass of 1 cm or larger (88.8% [237/267]; mean size, 1.8 ± 1.0 cm; range, 1.0-6.9 cm), an area of parenchymal distortion of 1 cm or greater (7.9% [21/267]; mean size, 1.8 ± 0.9 cm; range, 1.0-4.0 cm), or a new venous thrombus (3.4% [9/267]). Confirmatory testing with multiphase contrast-enhanced MRI or CT or with histopathology was available for 81.6% (218/267) of patients. Causes of US-3 observations included no abnormality at MRI or CT (41.3% [90/218]), a benign lesion (32.6% [71/218]), a LI-RADS category 3 (LR-3) observation at MRI or CT (5.5% [12/218]), a LI-RADS category 4 or 5 (LR-4 or LR-5) observation at MRI or CT or identification of HCC at histopathology (18.8% [41/218]), and an LR-M (denoting probably or definitely malignant but without specific features for HCC) observation at MRI or CT or other malignancy at histopathology (1.8% [4/218]). The PPV of a US-3 observation for probable or definite HCC was 18.8%, and for any malignancy it was 20.6%. CONCLUSION. In the HCC screening population, approximately one in five US-3 observations represents probable or definite HCC at multiphase MRI or CT or HCC at histopathology. These findings support current US LI-RADS guidelines to pursue further evaluation with multiphase cross-sectional imaging for US-3 observations.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Sistemas de Informação em Radiologia/estatística & dados numéricos , Ultrassonografia/métodos , Feminino , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco
7.
Eur J Radiol ; 142: 109859, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34284232

RESUMO

Portal vein thrombosis is a pathological condition characterized by the lumen occlusion of the portal vein and its intrahepatic branches, commonly associated to chronic liver diseases. Portal vein thrombosis is often asymptomatic and discovered as an incidental finding in the follow-up of chronic hepatopathy. Imaging plays a pivotal role in the detection and characterization of portal vein thrombosis in patients with hepatocellular carcinoma. Ultrasound and Color-Doppler ultrasound are usually the first-line imaging modalities for its detection, but they have limits related to operator-experience, patient size, meteorism and the restrained field-of view. Unenhanced cross-sectional imaging doesn't provide specific signs of portal vein thrombosis except under certain specific circumstances. Conventional contrast-enhanced imaging can depict portal vein thrombosis as an endoluminal filling defect best detected in venous phase and can differentiate between non-neoplastic and neoplastic thrombus based on the contrast enhanced uptake, but not always rule-out the malignant nature. Functional and quantitative imaging techniques and software seem to be more accurate. The purpose of this work is to provide the reader with an accurate overview focused on the main imaging features of portal vein thrombosis.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Trombose , Trombose Venosa , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem
8.
Abdom Radiol (NY) ; 46(8): 3686-3697, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34195886

RESUMO

Liver cancer is the fastest-growing cause of cancer deaths in the United States and is a complex disease. The response of hepatocellular carcinoma (HCC) to treatment can be variable. Predicting response to determine the most effective therapy is an active area of research. Our understanding of underlying factors which drive response to therapy is continually increasing. As more therapies for the treatment of this disease evolve, it is crucial to identify and match the ideal therapy for a particular tumor and patient. The potential predicative imaging features of tumor behavior, while of research interest, have not been validated for clinical use and do not currently inform treatment planning. If further validated though, prognostic features may be used in the future to personalize treatment plans according to individual patients and tumors. Unexpected post-treatment responses such as potential tumor biology changes and abscopal effect which are important to be aware of. This review is intended for radiologists who routinely interpret post treatment HCC imaging and is designed to increase their cognizance about how HCC tumor biology drives response to therapy and explore rare responses to therapy.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Biologia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Prognóstico
10.
Clinics (Sao Paulo) ; 76: e2888, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34287480

RESUMO

OBJECTIVES: To investigate whether quantitative textural features, extracted from pretreatment MRI, can predict sustained complete response to radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC). METHODS: In this IRB-approved study, patients were selected from a maintained six-year database of consecutive patients who underwent both pretreatment MRI imaging with a probable or definitive imaging diagnosis of HCC (LI-RADS 4 or 5) and loco-regional treatment with RFA. An experienced radiologist manually segmented the hepatic nodules in MRI arterial and equilibrium phases to obtain the volume of interest (VOI) for extraction of 107 quantitative textural features, including shape and first- and second-order features. Statistical analysis was performed to evaluate associations between textural features and complete response. RESULTS: The study consisted of 34 patients with 51 treated hepatic nodules. Sustained complete response was achieved by 6 patients (4 with single nodule and 2 with multiple nodules). Of the 107 features from the arterial and equilibrium phases, 20 (18%) and 25 (23%) achieved AUC >0.7, respectively. The three best performing features were found in the equilibrium phase: Dependence Non-Uniformity Normalized and Dependence Variance (both GLDM class, with AUC of 0.78 and 0.76, respectively) and Maximum Probability (GLCM class, AUC of 0.76). CONCLUSIONS: This pilot study demonstrates that a radiomic analysis of pre-treatment MRI might be useful in identifying patients with HCC who are most likely to have a sustained complete response to RFA. Second-order features (GLDM and GLCM) extracted from equilibrium phase obtained highest discriminatory performance.


Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Neoplasias Hepáticas , Ablação por Radiofrequência , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética , Projetos Piloto , Estudos Retrospectivos
11.
J Int Med Res ; 49(7): 3000605211024840, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34250825

RESUMO

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer mortality globally. In addition, most patients present in advanced stages with limited curative treatment options. Therefore, multidisciplinary treatment is often warranted. Here, we report a patient with HCC and severe arterioportal shunt (APS) who was treated with a multidisciplinary approach comprising interventional radiology procedures, apatinib and camrelizumab. After treatment, the intrahepatic mass was stable, and a notable decrease in the number and size of lung lesions was observed. The patient achieved a long-term survival of more than 2 years. These data suggest that multidisciplinary treatments may be effective in the treatment of advanced HCC with severe APS.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/tratamento farmacológico , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico
13.
Int J Hyperthermia ; 38(1): 1052-1059, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34251953

RESUMO

BACKGROUND: In patients with stage 0-A (as per Milan criteria) hepatocellular carcinoma (HCC) image-guided ablation is less invasive and requires shorter hospitalization than resection, but long-term prognosis is poorer. This meta-analysis was conducted to investigate whether liver stiffness measurement (LSM) could be used to predict prognosis in HCC patients after tumor ablation. METHODS: A literature search was conducted for all studies published till July 2020 in PubMed, Web of Science, Cochrane Library and EMBASE. Studies were included if they investigated the association between pretreatment LSM and prognosis in HCC patients treated with ablation. Subgroup analysis, meta-regression, publication bias assessment and sensitivity were conducted. RESULTS: Eight studies (with a total of 1276 HCC patients) were included in this meta-analysis. All patients were treated with radiofrequency ablation. Pooled results showed that high pretreatment LSM were associated with poor overall survival (OS) (hazard ratio [HR] = 4.31, 95% confidence interval [CI]: 2.27-8.20, p < .001) and recurrence-free survival (RFS), regardless of whether LSM was considered as a categorical variable (HR = 2.63, 95% CI = 1.63-4.22, p < .001) or as a continuous variable (HR = 1.02, 95% CI = 1.01-1.04, p = .003). Among studies treating LSM value as a categorical variable, liver stiffness measured using acoustic radio force impulse (ARFI) or transient elastography (TE) was significantly associated with RFS, but not liver stiffness measured using two-dimensional shear wave elastography (SWE). CONCLUSIONS: High baseline LSM value appears to be associated with poor prognosis in HCC patients treated with radiofrequency ablation.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Ablação por Radiofrequência , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Prognóstico
14.
Int J Hyperthermia ; 38(1): 1092-1098, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34296656

RESUMO

PURPOSE: This study aimed to investigate the technical efficiency and therapeutic response of fusion imaging (considered as virtual navigation) between contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) for the guidance of radiofrequency ablation (RFA) in patients with residual hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). METHODS: For this prospective study, 98 patients with residual HCC lesions after TACE treatment were enrolled between June 2017 and December 2020. All the lesions were invisible on conventional ultrasound scans. Percutaneous RFA was performed using either CEUS (CEUS group, 52 lesions) or virtual navigation (VN group, 46 lesions) guidance. The lesion display rate, disease-free survival rate, local recurrence rate, overall survival rate and complication incidence were calculated and compared. RESULTS: Fusion imaging had a significant impact on the RFA outcomes (hazard ratio, 2.629; 95% confidence interval, 1.256-5.505; p = .01). The median disease-free survival time of the VN group was significantly higher than that of the CEUS group (10.9 vs. 8.8 months; p = .007). The local recurrence rates after 3, 6 and 12 months in the VN group were significantly lower than those in the CEUS group (p = .014, .002 and .011). The minor complication rate was not significantly different between the two groups. CONCLUSIONS: CEUS-CECT/CEMRI fusion imaging for guiding RFA enables an efficient and useful therapy of inconspicuous HCC lesions after TACE. The novel solution prolongs the disease-free survival time and reduces the long-term local recurrence of residual lesions treated when using virtual-navigation (VN)-guided RFA.


Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Quimioembolização Terapêutica , Neoplasias Hepáticas , Ablação por Radiofrequência , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
15.
World J Surg Oncol ; 19(1): 181, 2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34154624

RESUMO

PURPOSE: We aimed to develop and validate a radiomics model for differentiating hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH) in non-cirrhotic livers using Gd-DTPA contrast-enhanced magnetic resonance imaging (MRI). METHODS: We retrospectively enrolled 149 HCC and 75 FNH patients treated between May 2015 and May 2019 at our center. Patients were randomly allocated to a training (n=156) and validation set (n=68). In total, 2260 radiomics features were extracted from the arterial phase and portal venous phase of Gd-DTPA contrast-enhanced MRI. Using Max-Relevance and Min-Redundancy, random forest, least absolute shrinkage, and selection operator algorithm for dimensionality reduction, multivariable logistic regression was used to build the radiomics model. A clinical model and combined model were also established. The diagnostic performance of the models was compared. RESULTS: Eight radiomics features were chosen for the radiomics model, and four clinical factors (age, sex, HbsAg, and enhancement pattern) were chosen for the clinical model. A combined model was built using the factors from the previous models. The classification accuracy of the combined model differentiated HCC from FNH in both the training and validation sets (0.956 and 0.941, respectively). The area under the receiver operating characteristic curve of the combined model was significantly better than that of the clinical model for both the training (0.984 vs. 0.937, p=0.002) and validation (0.972 vs. 0.903, p=0.032) sets. CONCLUSIONS: The combined model provided a non-invasive quantitative method for differentiating HCC from FNH in non-cirrhotic liver with high accuracy. Our model may assist clinicians in the clinical decision-making process.


Assuntos
Carcinoma Hepatocelular , Hiperplasia Nodular Focal do Fígado , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Meios de Contraste , Hiperplasia Nodular Focal do Fígado/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Prognóstico , Estudos Retrospectivos
16.
Yonsei Med J ; 62(7): 622-630, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34164960

RESUMO

PURPOSE: Expression of organic anion transporting polypeptides (OATPs) 1B1/1B3 in hepatocellular carcinoma (HCC) induces a paradoxical enhancement of gadoxetic acid on liver magnetic resonance imaging (MRI). We examined the expression profile of OATPs with regard to tumor differentiation in a genetically modified H-Ras 12V mouse model of spontaneous HCC that undergoes multistep hepatocarcinogenesis with minimal inter-individual variation. MATERIALS AND METHODS: Tumor nodules were harvested from transgenic H-Ras 12V mice. Hematoxylin and eosin-stained slides were examined for tumor differentiation and high-grade pathological components (tumor necrosis, thickened trabeculae, or vascular invasion). Immunohistochemistry of OATP 1B1/1B3 was performed, and OATP expression was assessed. RESULTS: We examined well-differentiated HCCs (n=59) in which high-grade pathological components were absent (n=49) or present (n=10). Among the well-differentiated HCCs without high-grade pathological components (n=49), OATP expression was negative, weak positive, and moderate positive in 23, 17, and nine cases, respectively. Among the well-differentiated HCCs with high-grade pathological components (n=10), OATP expression was negative, weak positive, and moderate positive in one, two, and seven cases, respectively. The ratio of positive OATP 1B1/1B3 expressing tumors was higher in HCCs with high-grade pathological components than in those without high-grade pathological components (p=0.004). CONCLUSION: Our findings support those of previous clinical studies that have reported the frequent appearance of gadoxetic acid-enhanced MRI in moderately differentiated HCC.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Transportadores de Ânions Orgânicos , Animais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/genética , Meios de Contraste , Gadolínio DTPA , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/genética , Imageamento por Ressonância Magnética , Camundongos , Camundongos Transgênicos , Peptídeos , Estudos Retrospectivos
17.
Eur J Radiol ; 141: 109807, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34146912

RESUMO

PURPOSE: We evaluated respiratory triggered unidirectional single-shot echo-planar imaging (u-SSEPI) as a time-saving measure in diffusion imaging of the upper abdomen. Specifically, we compared the ADC values obtained from unidirectional DWI (u-SSEPI) and routine DWI (4t-SSEPI) and also the diagnostic accuracies of unidirectional and routine DWI sequences in the identification of focal liver lesions in the setting of chronic liver disease (CLD). MATERIALS AND METHODS: This prospective, IRB approved study, included 48 patients of CLD who underwent-DCE-MRI on a 1.5 T scanner for hepatocellular carcinoma (HCC) workup. In addition to 4t-SSEPI, u-SSEPI was acquired with the diffusion sensitising gradient being applied in only one direction; keeping all other parameters same as 4t-SSEPI. Two blinded radiologists evaluated the DWI studies for image quality and detection of liver lesions. A composite gold standard was established using DCE-MRI, follow-up imaging and patient clinical details. The apparent diffusion coefficients (ADCs) of the liver, spleen and the lesions were compared between the two sequences. ROC analysis evaluated the diagnostic accuracy of ADC from both the sequences in identifying HCC. RESULTS: Eighty-eight lesions were identified using the composite gold standard. u-SSEPI resulted in 3 times faster image acquisition. No statistically significant differences were demonstrated between the unidirectional and routine DWI sequences for image quality parameters and lesion detection rates. Lesion wise comparison of the ADC values from both the sequences was not statistically different (p = 0.8) with a coefficient of variation = 12-14 %. The Bland- Altman plots and the Passing-Bablock regression analysis demonstrated a systematic and proportional bias between the ADC values obtained. The AUC of the ROC curve, however, was 0.63-observer1; 0.62-oobserver2 for routine DWI and 0.65; 0.62 for unidirectional DWI when ADC was used to identify HCC (the AUCs were not statistically different (p =  0.6-0.8)). CONCLUSION: No significant differences were demonstrated in the diagnostic accuracies of unidirectional and routine DWI in the diagnosis of HCC. Unidirectional diffusion may be further evaluated in other organs where diffusion is isotropic, especially in respiratory triggered sequences where the imaging time dividend is significant.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Estudos de Viabilidade , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Estudos Prospectivos , Reprodutibilidade dos Testes
19.
Acta Biomater ; 129: 245-257, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34082093

RESUMO

Effective and noninvasive diagnosis and prompt treatment of early-stage hepatocellular carcinoma (HCC) are urgently needed to reduce its mortality rate. Herein, the integration of high-resolution diagnostic second near-infrared (NIR-II) photoacoustic computed tomography (PACT) and imaging-guided targeted photothermal ablation of orthotopic small HCC (SHCC) is presented for the first time, which was enabled by a plasmonic platinum (Pt)-doped polydopamine melanin-mimic nanoagent. As designed, an antibody-modified nanoagent (designated Pt@PDA-c) with a plasmonic blackbody-like NIR absorption and superior photothermal conversion efficiency (71.3%) selectively targeted and killed CXCR4-overexpressing HCC (HepG2) cells, which was validated in in vitro experiments. The targeted accumulation properties of Pt@PDA-c in vivo were previously recognized by demonstrating effective NIR-II PA imaging and photothermal ablation in a subcutaneous HCC mouse model. Subsequently, with real-time quantitative guidance by PACT for the accurate diagnosis of intraabdominal SHCC (approximately 4 mm depth), the effective and noninvasive photothermal ablation of SHCCs was successfully demonstrated in an orthotopic tumor-bearing mouse model without damaging adjacent liver tissues. These results show a great potential of NIR-II PACT-guided noninvasive photothermal therapy as an innovative phototheranostic approach and expand the biomedical applications of melanin-mimic materials. STATEMENT OF SIGNIFICANCE: In this paper, we report the first diagnostic NIR-II photoacoustic computed tomography (PACT)-guided noninvasive photothermal ablation of small hepatocellular carcinoma (SHCC) located in deep tissues in orthotopic tumor-bearing mice; this process is empowered by a polydopamine-based melanin-mimic tumor-targeting nanoagent doped with plasmonic platinum that provides superior NIR-II (1064 nm) absorption and photothermal conversion efficiency of 71.3%. Following surface modification with anti-CXCR4 antibodies, the nanoagent (namely Pt@PDA-c) can selectively target CXCR4-overexpressed HepG2 carcinoma cells and tumor lesions, and serve as the theranostic agent for both NIR-II PACT-based diagnosis of orthotopic SHCC (diameter less than 5 mm) and efficient NIR-II PTT in vivo. This study may also extend the potential of melanin-derived blackbody materials for optical-biomedical and water distillation applications.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Nanopartículas , Neoplasias , Técnicas Fotoacústicas , Animais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Linhagem Celular Tumoral , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Melaninas , Camundongos , Fototerapia , Nanomedicina Teranóstica , Tomografia Computadorizada por Raios X
20.
Acta Biomater ; 130: 374-384, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34082098

RESUMO

Transcatheter arterial chemoembolization (TACE) is the main treatment for liver cancer. Although many embolic agents have been exploited in TACE, embolic agents combining embolization, drug loading, and imaging properties have not yet been constructed. Herein, we report a new magnetic mesoporous embolic microsphere that can simultaneously be loaded with doxorubicin (Dox), block vessels, and be observed by magnetic resonance imaging (MRI). The microspheres were prepared by decorating magnetic polystyrene/Fe3O4 particles with mesoporous organosilica microparticles (denoted as PS/Fe3O4@MONs). The PS/Fe3O4@MONs were uniformly spherical and large (50 µm), with a high specific surface area, uniform mesopores, and a Dox loading capacity of 460.8 µg mg-1. Dox-loaded PS/Fe3O4@MONs (PS/Fe3O4@MON@Dox) effectively inhibited liver cancer cell growth. A VX2 rabbit liver tumor model was constructed to study the efficacy of TACE with PS/Fe3O4@MON@Dox. In vivo, PS/Fe3O4@MON@Dox could be smoothly delivered through an arterial catheter to achieve chemoembolization. Moreover, PS/Fe3O4@MON@Dox and residual tumor parenchyma could be distinguished on MRI, which is of great significance for evaluating the efficacy of TACE. Histopathology showed that PS/Fe3O4@MON@Dox could be deposited in the tumor vessels, completely blocking the blood supply. Overall, PS/Fe3O4@MON@Dox showed good drug loading, embolization and imaging performance as well as potential for use in TACE. STATEMENT OF SIGNIFICANCE: Transcatheter arterial chemoembolization (TACE) is the main treatment for liver cancer. Although many embolic agents have been exploited in TACE, embolic agents combining embolization, drug-loading, and imaging properties have not yet been constructed. In this work, we prepared magnetic mesoporous microspheres as a new embolic agent that can simultaneously load doxorubicin (Dox), block blood vessels and enable magnetic resonance imaging. Overall, this new embolic microsphere-mediated TACE strategy for liver cancer showed good therapeutic effects, and the PS/Fe3O4@MON@Dox embolic microspheres provide a new avenue for improving the efficacy of TACE for liver cancer and postoperative evaluation.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Animais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Doxorrubicina/farmacologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Microesferas , Coelhos
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