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3.
Internist (Berl) ; 61(2): 123-130, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31919534

RESUMO

The imaging of focal liver lesions is a common task in daily radiological routine. The objectives of diagnostic imaging are, in addition to lesion detection, the characterization of the lesion as well as the follow-up assessment after surgical or local treatment or under systemic therapy. This article presents the typical morphologies observed in computed tomography and magnetic resonance imaging of hepatocellular carcinomas and intrahepatic cholangiocarcinomas as the most important representatives of primary malignant liver tumors and juxtaposes them with benign primary liver lesions such as adenoma and focal nodular hyperplasia (FNH). In addition, relevant technical aspects of imaging are briefly summarized. Finally, the main and additional criteria of the Liver Imaging Reporting and Data System (LI-RADS®) classification, which are becoming increasingly established clinically for the evaluation of liver lesions in the cirrhotic liver, are presented.


Assuntos
Neoplasias dos Ductos Biliares , Ductos Biliares Intra-Hepáticos , Carcinoma Hepatocelular , Hiperplasia Nodular Focal do Fígado , Neoplasias Hepáticas , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Diagnóstico Diferencial , Hiperplasia Nodular Focal do Fígado/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Imagem por Ressonância Magnética
4.
Z Gastroenterol ; 57(10): 1196-1199, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31610582

RESUMO

Many patients with intrahepatic cholelithiasis need surgical treatment during their life. For patients with hepatolithiasis, conventional therapy methods suggest partial hepatectomy or hepatic transplantation, while both kinds of surgery carry a considerable risk and trauma. Under such conditions, percutaneous transhepatic cholangioscopic lithotripsy provides an alternative method for hepatolithiasis treatment. Conventional rigid choledochoscope applied in percutaneous transhepatic cholangioscopic lithotripsy often lack sufficient flexibility for complete intrahepatic bile duct inspection. In this article, we report a case of one patient with complex hepatolithiasis and choledocholithiasis who received percutaneous transhepatic cholangioscopic lithotripsy using the newly-developed soft fiber-optic choledochoscope. This treatment represents a safe and effective outcome. We came to the conclusion that soft fiber-optic choledochoscope guided percutaneous transhepatic cholangioscopic lithotripsy seems a promising treatment option for selected patients with hepatolithiasis, especially for those who cannot accept conventional methods.


Assuntos
Coledocolitíase , Litotripsia , Hepatopatias , Idoso , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/cirurgia , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/patologia , Coledocolitíase/cirurgia , Humanos , Laparoscopia/instrumentação , Litotripsia/instrumentação , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Hepatopatias/cirurgia , Masculino , Resultado do Tratamento
5.
World J Gastroenterol ; 25(36): 5569-5577, 2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31576101

RESUMO

BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a type of tumor that presents in the intra- or extrahepatic bile ducts. Cystic-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis difficult. Because the growth of IPNB is slow, careful follow-up and timely therapeutic intervention is recommended. There are few reports with a follow-up period longer than a decade; thus, we report the case of a patient with an IPNB that grew for over 13 years. CASE SUMMARY: A 65-year-old man was diagnosed, 13 years prior with a cystic hepatic tumor with abnormal imaging findings. The targeted tumor biopsy results showed no malignancy. Biannual follow-up examinations were performed because of the potential for malignancy. The cystic lesions showed gradual enlargement over 11 years and a 4 mm papillary proliferation appeared on the cyst wall, which is compatible with IPNB. The tumor was observed for another 2 years because of the patient's wishes. The imaging findings showed enlargement to 8 mm and a new 9 mm papillary proliferation of the cystic tumor. Contrast-enhanced ultrasonography showed hyperenhancement during the arterial phase in both cyst walls, indicating intraductal tumor progression in both tumors. Thus, liver segment 8 subsegmentectomy was performed. The pathological findings indicated that the tumors contained mucin, and high-grade atypia was observed in the papillary lesions, showing IPNB. CONCLUSION: The development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/patologia , Carcinoma Papilar/diagnóstico , Cistos/patologia , Idoso , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Biópsia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Colangiografia , Cistos/cirurgia , Hepatectomia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
7.
Eur Radiol ; 29(7): 3725-3735, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30915561

RESUMO

OBJECTIVES: This study was conducted in order to establish and validate a radiomics model for predicting lymph node (LN) metastasis of intrahepatic cholangiocarcinoma (IHC) and to determine its prognostic value. METHODS: For this retrospective study, a radiomics model was developed in a primary cohort of 103 IHC patients who underwent curative-intent resection and lymphadenectomy. Radiomics features were extracted from arterial phase computed tomography (CT) scans. A radiomics signature was built based on highly reproducible features using the least absolute shrinkage and selection operator (LASSO) method. Multivariate logistic regression analysis was adopted to establish a radiomics model incorporating radiomics signature and other independent predictors. Model performance was determined by its discrimination, calibration, and clinical usefulness. The model was internally validated in 52 consecutive patients. RESULTS: The radiomics signature comprised eight LN-status-related features and showed significant association with LN metastasis in both cohorts (p < 0.001). A radiomics nomogram that incorporates radiomics signature and CA 19-9 level showed good calibration and discrimination in the primary cohort (AUC 0.8462) and validation cohort (AUC 0.8921). Promisingly, the radiomics nomogram yielded an AUC of 0.9224 in the CT-reported LN-negative subgroup. Decision curve analysis confirmed the clinical utility of this nomogram. High risk for metastasis portended significantly lower overall and recurrence-free survival than low risk for metastasis (both p < 0.001). The radiomics nomogram was an independent preoperative predictor of overall and recurrence-free survival. CONCLUSIONS: Our radiomics model provided a robust diagnostic tool for prediction of LN metastasis, especially in CT-reported LN-negative IHC patients, that may facilitate clinical decision-making. KEY POINTS: • The radiomics nomogram showed good performance for prediction of LN metastasis in IHC patients, particularly in the CT-reported LN-negative subgroup. • Prognosis of high-risk patients remains dismal after curative-intent resection. • The radiomics model may facilitate clinical decision-making and define patient subsets benefiting most from surgery.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Colangiocarcinoma/secundário , Linfonodos/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Colangiocarcinoma/diagnóstico , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
8.
World J Gastroenterol ; 25(5): 608-621, 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30774275

RESUMO

BACKGROUND: Intrahepatic sarcomatoid chonalgiocarcinoma (s-CCC) is an extremely rare disease, accounting for less than 1% of hepatobiliary system malignancies, and its pathophysiology is not well known. On the hypothesis that its clinical, serologic, or radiologic diagnosis are not fully understood and its prognosis is poor, we investigated the distinguishing features of s-CCC compared with those of intrahepatic bile duct adenocarcinoma [cholangiocellular carcinoma (CCC)] in patients from a single center. AIM: To analyze the clinical, serologic, imaging, and histopathologic characteristics of intrahepatic s-CCC patients diagnosed in a single center. METHODS: The clinical, serologic, imaging, and histopathologic features of 227 patients diagnosed with intrahepatic cholangiocarcinoma (IHCC) in a single medical center during the last 17 years were analyzed. The characteristics of 11 patients with s-CCC were compared with those of 216 patients with CCC. RESULTS: The number of patients with s-CCC who presented fever and abdominal pain and past history of chronic viral hepatitis or liver cirrhosis (LC) was higher than that of patients with CCC. In imaging studies, patients with s-CCC showed relatively aggressive features. However, no clear distinction was observed between s-CCC and CCC based on other clinical, serologic or radiologic examination results. An accurate diagnosis could be made only via a histopathologic examination through immunohistochemical staining. The clinical course of s-CCC was generally aggressive, and patients had a relatively poor prognosis. CONCLUSION: In patients with s-CCC, early diagnosis through biopsy and aggressive treatment, including surgical resection, are important.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/patologia , Doenças Raras/patologia , Sarcoma/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/terapia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/cirurgia , Biomarcadores Tumorais/sangue , Biópsia , Quimioterapia Adjuvante/métodos , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/mortalidade , Colangiocarcinoma/terapia , Feminino , Seguimentos , Hepatectomia , Humanos , Estimativa de Kaplan-Meier , Testes de Função Hepática , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Doenças Raras/diagnóstico , Doenças Raras/mortalidade , Doenças Raras/terapia , República da Coreia/epidemiologia , Estudos Retrospectivos , Sarcoma/diagnóstico , Sarcoma/mortalidade , Sarcoma/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
9.
Cancer Biother Radiopharm ; 34(4): 231-237, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30758985

RESUMO

Background: The aim of this study was to evaluate the safety and efficacy of repeated administration of 90Y-microspheres in intrahepatic cholangiocarcinoma (ICC) relapsed after the first radioembolization (RE). Methods: Nine patients with ICC relapsed after the first 90Y-RE were enrolled. Six patients presented recurrence in the right hepatic lobe, 3 in the left lobe. All subjects underwent a second administration of 90Y-resin microspheres. Toxicity was assessed according to Common Terminology Criteria for Adverse Events (CTCAE, version 4.02). After the repeated treatment, all patients were submitted to follow-up with laboratory, imaging, and clinical examinations. Results: The mean cumulative activity administered considering both treatments was 2.7 ± 0.5 GBq. After the second treatment, 3 patients presented complete metabolic response (33.3%) and 6 had partial response (66.6%). The following adverse events were registered: transient increased levels of liver enzymes (grade 1 = 4; grade 2 = 2), hyperbilirubinemia (grade 1 = 2), ascites (grade 2 = 1), and duodenal ulcer (grade 2 = 1). Two patients developed a significant shrinking of the targeted hepatic lobe, as for radiation lobectomy. No case of RE-induced liver disease was registered. Median overall survival was 16.5 ± 1.4 months after the first RE. Conclusions: The authors' results suggest that repeated administration of 90Y-microspheres may be considered in patients affected by ICC relapsed after the first 90Y-RE.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Colangiocarcinoma/terapia , Embolização Terapêutica/métodos , Recidiva Local de Neoplasia/terapia , Radioisótopos de Ítrio/administração & dosagem , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/efeitos da radiação , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/mortalidade , Colangiocarcinoma/patologia , Embolização Terapêutica/efeitos adversos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Fígado/diagnóstico por imagem , Fígado/efeitos da radiação , Masculino , Microesferas , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Retratamento/efeitos adversos , Retratamento/métodos , Estudos Retrospectivos , Resultado do Tratamento , Radioisótopos de Ítrio/efeitos adversos
10.
Anticancer Res ; 39(2): 903-907, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30711974

RESUMO

Neuroendocrine tumors usually develop in the gastrointestinal tract, pancreas, and lung. Therefore, a neuroendocrine tumor of the bile duct is quite rare. We present a 59-year-old-male patient whose preoperative diagnosis was hilar cholangiocarcinoma. One month after embolization of the left branch and anterior branch of the portal vein, he underwent left hepatic trisegmentectomy and extrahepatic bile duct resection. Pathological examination revealed the neuroendocrine tumor in the submucosal layer of the hilar bile duct. Because there was no neuroendocrine tumor in other organs, the tumor was considered a primary neuroendocrine tumor of the hilar bile duct, rather than a liver metastasis from other organs. We also present a review of the English literature regarding neuroendocrine tumors of the bile duct.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Extra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Biópsia , Colangiocarcinoma/patologia , Embolização Terapêutica , Hepatectomia , Humanos , Tumor de Klatskin/diagnóstico por imagem , Tumor de Klatskin/patologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/diagnóstico por imagem , Segunda Neoplasia Primária/patologia , Tumores Neuroendócrinos/patologia , Veia Porta/patologia
11.
BMC Infect Dis ; 19(1): 33, 2019 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-30621611

RESUMO

BACKGROUND: Hepatic clonorchiasis is one of the most prevalent food-borne parasitic diseases worldwide. Clonorchis sinensis, the pathogen, is the major parasitic trigger contributing to cholangitis, cholelithiasis, and even cholangiocarcinoma. Unfortunately, unspecific clinical manifestations of patients with hepatic clonorchiasis tend to mislead clinicians to neglect or misdiagnose them, following ignorance of appropriate therapy. Our case report may shed light on definite diagnosis of clonorchiasis with concomitant cholelithiasis, methodology for surgical drainage of the parasites, and postoperative anthelmintic therapy. CASE PRESENTATION: Two patients with habit of eating infected raw or undercooked freshwater fish were hospitalized due to right upper quadrant pain and jaundice. Magnetic resonance cholangiopancreatography (MRCP)/computed tomography (CT) detection indicated cholangiolithiasis and cholangiolithiasis with concurrent cholecystolithiasis, respectively. Fecal examinations were both negative for adult worms or eggs of parasites. However, adults of Clonrochis sinensis were detected within hepatobiliary tracts during laparoscopic cholecystectomy. Postoperative drainage and anthelmintic therapy contributed to complete recovery with good prognosis. CONCLUSIONS: Clonorchiasis provokes cholangiolithiasis and cholecystolithiasis. Standardized treatments for these gallstone patients with concomitant clonorchiasis include surgical removal of the calculus, postoperative T tubule drainage and anthelmintic therapy. Serological test or polymerase chain reaction (PCR)-based approaches might be helpful for diagnosis of clonorchiasis when no eggs are found by stool microscopy. Public health promotion on ceasing to eat raw freshwater fish is essential for prevention and control of clonorchiasis.


Assuntos
Sistema Biliar/diagnóstico por imagem , Sistema Biliar/parasitologia , Colangiopancreatografia por Ressonância Magnética/métodos , Clonorquíase/diagnóstico , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/parasitologia , Laparoscopia/métodos , Adulto , Animais , Anti-Helmínticos/uso terapêutico , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/parasitologia , Colecistectomia Laparoscópica , Clonorquíase/complicações , Clonorquíase/tratamento farmacológico , Clonorquíase/cirurgia , Clonorchis sinensis/isolamento & purificação , Feminino , Cálculos Biliares/diagnóstico , Cálculos Biliares/tratamento farmacológico , Cálculos Biliares/parasitologia , Cálculos Biliares/cirurgia , Humanos , Icterícia Obstrutiva/tratamento farmacológico , Icterícia Obstrutiva/cirurgia , Masculino , Pessoa de Meia-Idade
14.
Oncology ; 96(4): 192-199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30650415

RESUMO

AIM: Prognosis of hepatocellular carcinoma (HCC) with macrovascular invasion (MVI) is extremely poor. However, proper therapeutic strategies have not been established yet. The purpose of this study is to identify the effects of external beam radiation therapy (EBRT) for MVI of HCC. METHODS: We have analyzed and evaluated 80 consecutive patients with HCC with MVI who underwent EBRT, and factors associated with enhanced survival in EBRT were evaluated by univariate and multivariate analysis. RESULTS: The local response rate of radiotherapy for the irradiated MVI was 66.2%. The time to progression of the irradiated MVI was 5.8 months. Univariate and multivariate analyses showed that the higher irradiation dose (over 45 Gy) and the irradiation location (hepatic vein tumor thrombus - HVTT) were significant factors associated with survival benefits of EBRT. The response of EBRT for HVTT was significantly superior to that for portal vein or bile duct tumor thrombus. CONCLUSION: We conclude that a multidisciplinary therapeutic strategy based on EBRT should be proactively selected in the treatment of advanced HCC with MVI.


Assuntos
Ductos Biliares Intra-Hepáticos/efeitos da radiação , Carcinoma Hepatocelular/radioterapia , Veias Hepáticas/efeitos da radiação , Neoplasias Hepáticas/radioterapia , Veia Porta/efeitos da radiação , Dosagem Radioterapêutica , Adulto , Idoso , Idoso de 80 Anos ou mais , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Feminino , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/patologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Cardiovasc Intervent Radiol ; 42(5): 784-786, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30684010

RESUMO

Sixty-four-year-old female who underwent hemi-hepatectomy for intrahepatic cholangiocarcinoma a year ago presented with biliary sputum, cough and fever. Cross-sectional imaging showed a recurred tumor involving right diaphragmatic area and an abscess formation in liver dome with adjacent right lower lobe of lung. Percutaneous transhepatic biliary drainage and percutaneous drainage of lung abscess were performed. Tubogram showed connections between the lung abscess cavity and multiple distal bronchi, suggesting bronchobiliary fistulas. Two weeks of drainage treatment did not relieve symptoms. We successfully treated intractable bronchobiliary fistula via image-guided percutaneous access to closest distal bronchi near abscess with subsequent tandem placement of vascular plugs.


Assuntos
Fístula Biliar/terapia , Fístula Brônquica/terapia , Embolização Terapêutica/métodos , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Fístula Biliar/complicações , Fístula Biliar/diagnóstico por imagem , Brônquios/diagnóstico por imagem , Fístula Brônquica/complicações , Fístula Brônquica/diagnóstico por imagem , Drenagem , Feminino , Humanos , Abscesso Pulmonar/complicações , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/terapia , Pessoa de Meia-Idade , Radiografia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Eur J Surg Oncol ; 45(2): 192-197, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30297275

RESUMO

AIMS: Cholangiocarcinoma is a rare cancer arising from the biliary tree. Case series indicate that 25-40% of all borderline resectable primary tumours are potentially resectable. The Memorial Sloane Kettering System (MSKCC) stratifies patients for resectability by longitudinal and radial extension of the hilar tumour. The Bismuth-Corlette system describes the longitudinal extension of the tumour within the biliary duct system. We sought to validate and, if possible, augment these two scores within an independent validation cohort. METHODS: Patients diagnosed with hilar cholangiocarcinoma between January 2009 and December 2016 were analysed from a prospectively held database. Patients with distal cholangiocarcinoma, peripheral cholangiocarcinoma and gallbladder cancer were excluded. Comparison of surgical findings to pre-operative radiological imaging was undertaken at the time of surgery. RESULTS: The validation cohort was formed of 198 patients, of which, 55 (27.8%) patients underwent resection. Logistic regression analyses identified that BC score, MSKCC score, age at diagnosis and left artery involvement were all significant independent predictor's univariately. BC score explained 28% of the variability in resectability compared to 26% explained by MSKCC. In combination, the model consisting of BC score, age at diagnosis and left artery involvement explained 39% of variability in resectability compared to the 34% explained same model including MSKCC score instead of BC score. CONCLUSION: In this cohort an augmented BC score, incorporating left hepatic artery involvement, is more discriminative in predicting resectability than the current MSKCC system.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/cirurgia , Cuidados Pré-Operatórios , Tomografia Computadorizada por Raios X , Idoso , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/patologia , Feminino , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/patologia , Artéria Hepática/cirurgia , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento
18.
Eur Radiol ; 29(3): 1460-1468, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30159619

RESUMO

AIMS: To evaluate the prognostic value of cystic dilatation (CD) of the intrahepatic biliary ducts in patients with primary sclerosing cholangitis (PSC). METHODS: A single-center cohort of 205 patients with PSC from 2003 to 2016 was analysed. CD was defined by quantitative and qualitative criteria. Radiological and clinical courses were assessed. A Kaplan-Meier analysis was used to estimate cumulative survival without liver transplantation (LT) from the date of PSC diagnosis. A log-rank test was performed to compare survival time of PSC patients with and without CD. RESULTS: A total of 15 (7.3%) PSC patients (12 males) with a median age of 23 years at diagnosis had CD. Five patients had one CD; seven patients had two or three CDs; and three patients had diffuse CD. CDs ranged in small diameter size from 12 to 32 mm. Radiological evolution of CD was markedly variable. However, a radiological worsening of PSC over time was observed in all patients. The clinical course was characterized by the occurrence of complications in most patients. Half of the patients with CD underwent LT at a median time of 40 months from diagnosis of CD and the median survival time from PSC diagnosis was significantly lower than in PSC without CD (10.7 vs. 23.4 years; HR 3.8, 95% confidence interval: 1.7-8.3, p = 0.001). CONCLUSIONS: CD in PSC is an unusual condition that mostly affects young patients. It is characterized by a rapid, unfavorable course and constitutes a significant prognostic factor. KEY POINTS: • Cystic dilatation of the intrahepatic biliary ducts affects young patients with primary sclerosing cholangitis and is characterized by a markedly variable radiological evolution. • Biliary wall inflammation, found in explanted livers, could be a key feature in the pathogenesis of cystic dilatation. • Cystic dilatation of the intrahepatic biliary ducts is characterized by an unfavorable course and constitutes a significant prognostic factor of primary sclerosing cholangitis.


Assuntos
Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Colangiopancreatografia por Ressonância Magnética/métodos , Colangite Esclerosante/diagnóstico , Imageamento Tridimensional , Fígado/diagnóstico por imagem , Adolescente , Adulto , Dilatação Patológica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
19.
Eur Radiol ; 29(6): 3132-3140, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30519930

RESUMO

OBJECTIVES: To identify imaging features that assist in discriminating intraductal papillary neoplasms of the bile duct (IPNBs) from papillary cholangiocarcinomas (PCCs). METHODS: This study was approved by the institutional review board. Using the recently proposed histological diagnostic criteria for biliary papillary neoplasms, IPNBs and PCCs were selected from 537 biliary neoplasms consecutively resected in a 12.5-year period. Clinical and imaging features were compared between the two groups. RESULTS: The histology review identified 19 IPNBs and 48 PCCs, representing an estimated prevalence of IPNBs among biliary neoplasms of 4%. Approximately one half of IPNBs were incidentally found on imaging conducted for other purposes. In terms of tumor location, 15/19 IPNBs (79%) developed in intrahepatic bile ducts, and 41/48 PCCs (85%) in the distal bile duct. Cystic appearance was highly suggestive for IPNBs (p < 0.001). Using these two parameters, 78% of papillary bile duct neoplasms could be classified into IPNBs or PCCs. Other imaging findings favoring IPNBs included frond-like mural nodule, downstream bile duct dilatation, and the lack of abnormal enhancement in the adjacent bile duct. Interestingly, two patients with non-invasive or microinvasive IPNB had undergone abdominal imaging studies > 3 years before, and a retrospective review of the previous images identified small nodular or cystic lesions, suggesting a less progressive nature of IPNBs than currently thought. CONCLUSIONS: Imaging findings useful for discriminating IPNBs from PCCs appear to be tumor location, shape of tumor, appearance of mural nodules, duct dilatation at unaffected duct, and abnormal enhancement of the adjacent bile duct. KEY POINTS: • Intrahepatic location and cystic dilatation of the affected bile duct are the strong discriminators between IPNBs and PCCs. • The shape of the mural nodule and appearance of the neighboring bile duct are helpful for distinguishing IPNBs and PCCs. • The less aggressive behavior of IPNBs compared with PCCs may facilitate less invasive management in patients with IPNB.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Carcinoma Papilar/diagnóstico , Colangiocarcinoma/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Eur Radiol ; 29(5): 2408-2416, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30552477

RESUMO

OBJECTIVES: To investigate the diagnostic accuracy of each LR-M feature defined in version 2017 of the Liver Imaging Reporting and Data System (LI-RADS) and determine the optimal LR-M feature for differentiating combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and hepatocellular carcinoma (HCC) on gadoxetate-enhanced magnetic resonance imaging (MRI). METHODS: Ninety-nine patients with pathologically proven cHCC-CCA (n = 33) or HCC (n = 66) after surgery were identified. Two radiologists retrospectively assessed preoperative gadoxetate-enhanced MRI for features favoring non-HCC malignancies (LR-M features) according to LI-RADS version 2017. Multivariate logistic regression analysis was performed to determine the independent differential features. The sensitivity and specificity for diagnosing cHCC-CCA were calculated for each LR-M feature. RESULTS: Targetoid appearance showed the highest sensitivity (75.8%, 95% confidence interval [CI] 60.6%, 87.3%) to correctly identify cHCC-CCA as LR-M. At least one LR-M feature was observed in 31 (93.9%) patients with cHCC-CCA and 34 (51.5%) patients with HCC. The sensitivity and specificity for diagnosing cHCC-CCA using the presence of any one of the LR-M features were 93.9% (95% CI 80.7, 98.9) and 48.5% (95% CI 41.9, 51.0), respectively. The presence of three LR-M features yielded the highest diagnostic accuracy of 80.8% (95% CI 72.1, 86.1) with a reduced sensitivity of 54.5% (95% CI 41.4, 62.5). CONCLUSION: The majority of cHCC-CCA cases can be properly categorized as LR-M when any one of the LR-M features defined in the LI-RADS version 2017 is used as a determiner. However, approximately half of HCC cases also show at least one LR-M feature. KEY POINTS: • Targetoid appearance, including rim APHE, peripheral "washout" appearance, and delayed central enhancement, was the LR-M feature that identified cHCC-CCA as a non-HCC malignancy with the highest sensitivity. • Most cHCC-CCA cases can be properly categorized as LR-M when the presence of any one of the LR-M features was used as the determiner. • Approximately half of HCC cases also showed at least one LR-M feature.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico , Colangiocarcinoma/diagnóstico , Gadolínio DTPA/farmacologia , Neoplasias Hepáticas/diagnóstico , Imagem por Ressonância Magnética/métodos , Meios de Contraste/farmacologia , Sistemas de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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