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1.
Vasc Endovascular Surg ; 54(1): 36-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31570064

RESUMO

OBJECTIVES: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. METHODS: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. RESULTS: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries (P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). CONCLUSION: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.


Assuntos
Veias Hepáticas/lesões , Veia Porta/lesões , Lesões do Sistema Vascular/epidemiologia , Adolescente , Adulto , Criança , Bases de Dados Factuais , Feminino , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia , Adulto Jovem
2.
Medicine (Baltimore) ; 98(45): e17877, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702657

RESUMO

RATIONALE: Budd-Chiari syndrome (BCS), which causes congestive hepatopathy and aggravates cirrhosis, is typically treated by interventional angioplasty to ameliorate blood flow. X-ray venography is useful for the evaluation of inferior vena cava (IVC) stenosis and determination of treatment timing, but it is invasive and thus unsuitable for repeated examinations. The development of a simple method for the prediction of IVC stenosis would reduce the burden on patients with BCS. PATIENT CONCERNS: We report here our experience of 2 patients with BCS who underwent percutaneous transluminal angioplasty (PTA). The first patient was a 39-year-old male who underwent PTA to expand his stenotic IVC. The second patient was a 19-year-old male who underwent PTA 3 times due to restenosis of his IVC. DIAGNOSES: Both patients were diagnosed with BCS with severe obstruction of the IVC. INTERVENTIONS: We evaluated the hepatic vein (HV) waveform by Doppler ultrasonography and measured liver stiffness (LS) using transient elastography (TE) before and after PTA. OUTCOMES: In case 1, the phasic oscillation of the HV waveform recovered and the LS value decreased after PTA. Both improvements were maintained for ∼3 years, reflecting the long-term patency of the IVC. In case 2, the HV waveform and the LS value improved temporarily after PTA, but then deteriorated gradually. Monitoring of the HV waveform and LS value allowed retreatment prior to total occlusion of the IVC and abrogated the risk of intravascular needle puncture. LESSONS: Monitoring of the HV waveform and the LS value enables safe management of patients with BCS who may require PTA.


Assuntos
Síndrome de Budd-Chiari/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Veias Hepáticas/diagnóstico por imagem , Adulto , Angioplastia com Balão , Síndrome de Budd-Chiari/complicações , Síndrome de Budd-Chiari/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Veias Hepáticas/cirurgia , Humanos , Masculino , Ultrassonografia Doppler , Adulto Jovem
3.
Br J Radiol ; 92(1102): 20190487, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271536

RESUMO

OBJECTIVES: The purpose of the study was to assess the incidence of hepatic vein variations on multidetector CT (MDCT) for abdominal examinations. METHODS: A retrospective analysis of 534 MDCT scans was performed in patients sent for various abdominal pathologies between January 2017 and April 2019. After excluding 34 patients, finally total of 500 patients (N = 500) were included in the study. For simplification, we classified the hepatic vein variations as classified by Soyer et al, Fang et al and Cheng et al. RESULTS: Single right hepatic vein was seen in 458 (91.6%) out of 500 patients in our study. Two right hepatic veins were seen in 36 patients out of which 27 had common trunk and nine had independent drainage into the inferior vena cava (IVC). Common trunk of middle hepatic vein (MHV) and left hepatic vein (LHV) was seen in 405 (81%) and independent drainage of MHV and LHV into the IVC was seen in 95 (19%) of patients in our study. Amongst the segmental hepatic vein variations, most common drainage of segment IV vein was into LHV (333,66.6%) followed by MHV (148,29.6%) and IVC (19,3.8%). CONCLUSION: Hepatic vein variations are commonly seen similar to variations in hepatic artery, portal vein and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists. ADVANCES IN KNOWLEDGE: Awareness of the hepatic vein variations is essential for intervention radiologists and surgeons to reduce iatrogenic complications.


Assuntos
Veias Hepáticas/anatomia & histologia , Veias Hepáticas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Cardiovasc Intervent Radiol ; 42(9): 1311-1321, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31218407

RESUMO

OBJECTIVE: This retrospective study evaluated interventional treatments (recanalization, balloon dilation, and/or stent placement) for Budd-Chiari syndrome (BCS), caused by combined obstruction of the inferior vena cava (IVC) and hepatic veins (HVs). METHODS: Before and after interventional therapy, patients with BCS (n = 162; asymptomatic 105.2 ± 103.3 mo; follow-up 15 [6-24] mo) underwent imaging studies (color Doppler ultrasound, CT, or MRI), and inferior vena cavography and manometry. Venous lesions were characterized by occlusion features, and presence of thrombosis and peripheral collateral vessels. RESULTS: One, 2, and 3 main HV occlusions were observed, respectively, in 25 (15.4%), 61 (37.7%), and 76 (46.9%) patients. Eighty-three (51.2%), 98 (60.5%), and 104 (64.2%) patients had, respectively, large accessory HVs, venous collaterals formed between the HVs, or venous communicating branches between the HV and the peritoneal veins. The middle, left, and right HV was patent in 32 (19.8%), 35 (21.6%), and 44 (27.2%) patients. Recanalization of both hepatic and caval occlusions was successful in 96% (51/53) of those attempted; recanalization of IVC occlusion was successful in 97% (106/109). Among 157 patients successfully treated, 146 were cured and 11 showed clinical improvement. Clinical symptoms were relieved in 82.4% after the initial intervention, and 94.2% after the second intervention. CONCLUSION: Recanalization and balloon angioplasty was effective for the management of BCS with concurrent HV and IVC occlusions. The majority of patients required only IVC recanalization. The outcome of patients treated only by IVC intervention was similar to that of patients given combined HV and IVC intervention.


Assuntos
Síndrome de Budd-Chiari/cirurgia , Procedimentos Endovasculares/métodos , Veias Hepáticas/patologia , Veias Hepáticas/cirurgia , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Adolescente , Adulto , Idoso , Angioplastia com Balão/métodos , China , Diagnóstico por Imagem/métodos , Feminino , Veias Hepáticas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Adulto Jovem
6.
Expert Rev Gastroenterol Hepatol ; 13(5): 463-484, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30895833

RESUMO

INTRODUCTION: Veno-occlusive-disease (VOD), known also as sinusoidal-obstruction-syndrome (SOS), is one of the main complications of haematopoietic stem cell transplantation and is related to the treatment with pyrrolizidine alkaloids or other toxic agents (chemotherapy for liver-metastasis). Clinical diagnosis using the recent criteria from the European Society for Blood and Marrow Transplantation, is the reference for VOD/SOS diagnosis. However, increasing evidence suggests the emerging role of several imaging methods that could help the clinician in VOD/SOS assessment. Areas covered: This review evaluates the current literature on the various imaging techniques used in VOD/SOS diagnosis in several clinical scenarios. Literature searches were performed using several keywords on MEDLINE/Ovid/In-Process/Cochrane Library/EMBASE and PubMed up to July 2018. Expert commentary: Hepatic-gradient-measurement (HVPG) and contextual transjugular-liver-biopsy are invasive and should always be considered in unclear cases. The main studies revolve around ultrasound with Doppler evaluation, identifying numerous findings suggestive of VOD/SOS. However, their accuracy and validation are still suboptimal and controversial. CT-Scan and MRI have shown encouraging data in other contexts in which VOD/SOS can develop, but studies on the post-HSCT patient are lacking. Elastography techniques measuring liver stiffness (LSM) represent the most recent and promising approach for an accurate and early diagnosis of VOD/SOS. In our view, a multidisciplinary approach to the VOD/SOS diagnosis should be highly encouraged.


Assuntos
Veias Hepáticas/diagnóstico por imagem , Hepatopatia Veno-Oclusiva/diagnóstico por imagem , Ultrassonografia Doppler/tendências , Animais , Antineoplásicos/efeitos adversos , Angiografia por Tomografia Computadorizada/tendências , Difusão de Inovações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hepatopatia Veno-Oclusiva/etiologia , Humanos , Angiografia por Ressonância Magnética/tendências , Flebografia/tendências , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Risco
7.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 30(6): 671-673, 2019 Feb 20.
Artigo em Chinês | MEDLINE | ID: mdl-30891982

RESUMO

OBJECTIVE: To evaluate the accuracy of CT imaging of inferior vena cava and hepatic vein in patients with hepatic cystic echinococcosis. METHODS: A total of 100 patients with hepatic cystic echinococcosis were given triple-phase abdominal CT scan, and the reconstructed images of the inferior vena cava and hepatic vein were obtained and compared to the real situation during the surgical operation. The reliability of the CT evaluation of the echinococcus cyst lesion invading inferior vena cava and hepatic vein was analyzed. RESULTS: The compression displacement, half-globular, no clear demarcation between the lesion and blood vessel and narrowing of the vessel detected by CT evaluation were in accordance with the real situation under the surgical sight. However, four cases of clear demarcation between the lesion and blood vessel were affirmed wrong under the surgical sight. There were three cases of over diagnosis of vascular stenosis judgments. CONCLUSIONS: The CT images of hepatic vein and inferior vena cava can clearly show the relationship between the hepatic echinococcus cyst and hepatic vein and inferior vena cava.


Assuntos
Equinococose , Veias Hepáticas , Tomografia Computadorizada por Raios X , Veia Cava Inferior , Animais , Equinococose/diagnóstico por imagem , Veias Hepáticas/diagnóstico por imagem , Humanos , Reprodutibilidade dos Testes , Veia Cava Inferior/diagnóstico por imagem
8.
Clin J Gastroenterol ; 12(4): 361-366, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30762212

RESUMO

Hepatic angiomyolipoma (AML) is a rare stromal tumor composed of variable admixtures of thick-walled vessels, smooth muscles and adipose tissue. One of the specific radiological findings of hepatic AML is an early drainage vein noted via enhanced computed tomography (CT). We report a case of hepatic AML showing early drainage veins into both the hepatic and portal vein. The case involved a 46-year-old woman who was referred to our hospital because of a giant hepatic tumor. CT revealed well-enhanced 14 cm and 1 cm tumors in the left and right lobes, respectively. Magnetic resonance imaging demonstrated the existence of adipose tissues in the larger tumor. Hepatic arteriography revealed early drainage veins draining into both the hepatic and portal vein. Based on a diagnosis of hepatic AML, left hepatectomy and partial hepatectomy were performed. Pathology revealed both tumors as hepatic AML based on human melanoma black-45 immuno-positivity. Hepatic AML with early drainage veins into both the hepatic and portal vein is rare. The dilated and retrogressive vein drains the abundant arterial blood flow of the tumor. The finding of early drainage veins into not only the hepatic vein but also the portal vein should be helpful for diagnosing hepatic AMLs.


Assuntos
Angiomiolipoma/irrigação sanguínea , Veias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/irrigação sanguínea , Veia Porta/diagnóstico por imagem , Angiografia , Angiomiolipoma/diagnóstico por imagem , Angiomiolipoma/patologia , Angiomiolipoma/cirurgia , Feminino , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
9.
Med Sci Monit ; 25: 920-927, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30707686

RESUMO

BACKGROUND The current study investigated the detection of accessory hepatic veins and their vascular territories in the right hemiliver in rats, guinea pigs, and rabbits, which has become a prerequisite for newly developed clinical procedures. We compared the anatomical continuity of accessory hepatic veins with accessory hepatic veins existing in human livers. MATERIAL AND METHODS The analysis of accessory hepatic veins was performed using a corrosion cast method in combination with computer tomography (CT). RESULTS In normal livers, accessory hepatic veins were regularly found. The length of these veins was 0.88±0.29 (cm ±SD) in rats, 1.10±0.39 in guinea pigs, and 1.28±0.48 in rabbits. Accessory hepatic veins became a part of the draining vessel draining into segment VI and VII; represented by interpolating and following Chouinard's segmental concept. CONCLUSIONS The importance of detecting accessory hepatic veins lies in the identification of structures requiring special attention during surgery, in reduction of surgical complications, and in choosing the best approach to maintain the vitality of a drainage segment. The vascular reconstruction should be done during surgical interventions.


Assuntos
Veias Hepáticas/diagnóstico por imagem , Imagem Tridimensional/métodos , Fígado/cirurgia , Animais , Animais de Laboratório , Feminino , Cobaias , Hepatectomia/métodos , Humanos , Fígado/anatomia & histologia , Transplante de Fígado/métodos , Masculino , Coelhos , Ratos , Ratos Wistar , Procedimentos Cirúrgicos Reconstrutivos/métodos
10.
Eur Radiol ; 29(9): 5013-5021, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30737565

RESUMO

OBJECTIVES: Invasive treatment of tumors adjacent to large hepatic vessels is a continuous clinical challenge. The primary aim of this study was to examine the feasibility of ablating liver tissue adjacent to large hepatic and portal veins with magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU). The secondary aim was to compare sonication data for ablations performed adjacent to hepatic veins (HV) versus portal veins (PV). MATERIALS AND METHODS: MRgHIFU ablations were performed in six male land swine under general anesthesia. Ablation cells of either 4 or 8 mm diameter were planned in clusters (two/animal) adjacent either to HV (n = 6) or to PV (n = 6), with diameter ≥ 5 mm. Ablations were made using 200 W and 1.2 MHz. Post-procedure evaluation was made on contrast-enhanced MRI (T1w CE-MRI), histopathology, and ablation data from the HIFU system. RESULTS: A total of 153 ablations in 81 cells and 12 clusters were performed. There were visible lesions with non-perfused volumes in all animals on T1w CE-MRI images. Histopathology showed hemorrhage and necrosis in all 12 clusters, with a median shortest distance to vessel wall of 0.4 mm (range 0-2.7 mm). Edema and endothelial swelling were observed without vessel wall rupture. In 8-mm ablations (n = 125), heat sink was detected more often for HV (43%) than for PV (19%; p = 0.04). CONCLUSIONS: Ablations yielding coagulative necrosis of liver tissue can be performed adjacent to large hepatic vessels while keeping the vessel walls intact. This indicates that perivascular tumor ablation in the liver is feasible using MRgHIFU. KEY POINTS: • High-intensity focused ultrasound ablation is a non-invasive treatment modality that can be used for treatment of liver tumors. • This study shows that ablations of liver tissue can be performed adjacent to large hepatic vessels in an experimental setting. • Liver tumors close to large vessels can potentially be treated using this modality.


Assuntos
Veias Hepáticas/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Neoplasias Hepáticas/cirurgia , Imagem por Ressonância Magnética/métodos , Veia Porta/cirurgia , Cirurgia Assistida por Computador/métodos , Animais , Modelos Animais de Doenças , Veias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/irrigação sanguínea , Masculino , Veia Porta/diagnóstico por imagem , Suínos
11.
J Vasc Interv Radiol ; 30(7): 1043-1047, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30772167

RESUMO

PURPOSE: To evaluate efficacy and safety of transjugular liver biopsy (TJLB) via the left hepatic vein in patients with left lobe-only liver transplants (LLOTs). MATERIALS AND METHODS: Retrospective review revealed 43 TJLBs performed in 26 patients with LLOTs (mean age 51.3 y; range, 18-73 y) between January 2009 and June 2016 at a single institution. A comparison group of 44 randomly selected TJLBs performed in 37 orthotopic whole liver transplant (OWLT) recipients (mean age 57.6 y; range, 35-74 y) during the same time period was evaluated. Patient demographics, type and age of transplant, technical success, adequacy of samples, number of portal tracts obtained, pathologic diagnosis, and complication rate were reviewed. RESULTS: Technical success was achieved in 98% (42/43) of LLOT procedures. TJLB failed in 1 patient with LLOT, in whom no patent hepatic veins were identified. Technical success was achieved in 100% (44/44) in the OWLT group. Mean (SD) number of needle passes was 4.12 (1.25) in the LLOT group vs 3.95 (1.28) in the OWLT group (P = .54). Mean (SD) specimen length was 1.16 (0.75) cm in the LLOT group vs 1.19 (0.58) cm in the OWLT group (P = .78). Mean (SD) number of portal tracts obtained in the LLOT group was 10.7 (5.26) vs 12.3 (4.68) in the OWLT group (P = .17). No major complications were observed in either group. CONCLUSIONS: TJLB in adult patients with LLOTs appears safe and feasible, with favorable rates of technical success and adequacy of sampling.


Assuntos
Biópsia por Agulha/métodos , Cateterismo Venoso Central/métodos , Veias Hepáticas , Biópsia Guiada por Imagem/métodos , Veias Jugulares , Transplante de Fígado , Complicações Pós-Operatórias/patologia , Adolescente , Adulto , Idoso , Angiografia Digital , Biópsia por Agulha/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Feminino , Veias Hepáticas/diagnóstico por imagem , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Veias Jugulares/diagnóstico por imagem , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Flebografia , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Radiografia Intervencionista , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
13.
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.
Z Med Phys ; 29(2): 173-183, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30266458

RESUMO

PURPOSE: To investigate the capabilities of a modern pseudo-continuous arterial spin labeling (PCASL) technique for non-invasive assessment of the temporal and spatial distribution of the liver perfusion in healthy volunteers on a clinical MR system at 3T. MATERIALS AND METHODS: A 2D-PCASL multi-slice echo planar imaging sequence was adapted to the specific conditions in liver: a) labeling by PCASL was optimized to the flow characteristics in the portal vein, b) background suppression was applied for reduction of motion related artifacts, c) post labeling delays (PLDs) were varied over a large range (0.7-3.5s) in order to get better insight in the temporal and spatial distribution of tagged blood in the liver, and d) a special timed-breathing protocol was used allowing for recording of 16 to 18 label-control image pairs and a reference M0 image for each of 4 to 6 slices within approx. 5min for one PLD. RESULTS: Measurements with multiple PLDs showed dominating perfusion signal in macroscopic blood vessels for PLDs up to 1.5 s, whereas pure liver parenchyma revealed maximum perfusion signal for a PLD of approx. 2 s, and detectable signal up to PLDs of 3.5 s. Data fitting to a perfusion model for liver provided a mean global perfusion of 153±15ml/100g/min and a mean transit time of 1938±332ms in liver parenchyma. Measurements with a single PLD of 2 s demonstrated that portal-venous and arterial perfusion components can be measured separately by two measurements with two different positions of the labeling plane (one for labeling of the global hepatopetal blood flow and one for selective labeling of the portal blood flow only). Relative contribution of blood from the hepatic artery to the global liver perfusion, the hepatic perfusion index (HPI), amounted to approx. 23%. CONCLUSION: Modern and adapted protocols for assessment of liver perfusion by PCASL have the potential to provide perfusion and blood transit time maps in reasonable acquisition time.


Assuntos
Veias Hepáticas/diagnóstico por imagem , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Imagem por Ressonância Magnética , Imagem de Perfusão/métodos , Veia Porta/diagnóstico por imagem , Marcadores de Spin , Adulto , Feminino , Voluntários Saudáveis , Veias Hepáticas/fisiologia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Veia Porta/fisiologia , Análise Espaço-Temporal , Adulto Jovem
16.
Transplant Proc ; 50(10): 3100-3104, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577173

RESUMO

Splitting deceased donor livers and creating 3 grafts from a whole liver may be feasible and shorten the waiting time for organ donation in patients with high mortality rates. We hypothesized that it might be reasonable to procure 3 grafts for donation from one deceased donor liver by splitting the liver into left (segment II, III, IV), right anterior (segment V, VIII), and right posterior lobes (segment VI, VII) for liver transplantation according to the portal system trifurcated variations. We designed the right anterior branch with the main portal trunk and middle hepatic artery to become inflow of right anterior lobe, the left portal vein and left hepatic artery to become the inflow of left lobe and right posterior branch, and right hepatic artery to become the inflow of right posterior lobe. We retrospectively reviewed the volumetric computed tomography and magnetic resonance cholangiopancreatography of 153 liver donors. The hepatic and portal veins, hepatic artery, and biliary system were reorganized and classified. The volumetric proportions of the liver grafts were measured. Trifurcation of the portal vein variation was found in approximately 13.7% of portal systemic variations. The left lobe accounted for 29.18% of the total liver volume, the right anterior lobe, 35.22%, and the right posterior lobe, 35.6%. We validated this principle by dissecting the explanted liver and identified the triple grafts' weights, percentages, vessels, and biliary ducts system. The splitting of deceased donor livers into 3 split liver grafts for use in liver transplantation surgery can be clinically useful.


Assuntos
Aloenxertos/irrigação sanguínea , Transplante de Fígado/métodos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Adulto , Sistema Biliar/diagnóstico por imagem , Colangiopancreatografia por Ressonância Magnética , Tomografia Computadorizada de Feixe Cônico , Feminino , Artéria Hepática/diagnóstico por imagem , Veias Hepáticas/diagnóstico por imagem , Humanos , Masculino , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos
17.
Eur J Radiol ; 108: 133-139, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30396646

RESUMO

OBJECTIVES: Advanced chronic liver disease is frequent yet largely underdiagnosed. Doppler-US is a common examination and we recently identified three simple Doppler-US signs associated with severe liver fibrosis. Recent Doppler-US devices include elastography modules, allowing for liver stiffness measurement (LSM). Our aim was to assess whether the use of elastography following positive simple Doppler-US signs improves the detection of severe liver fibrosis in a single Doppler-US examination. METHODS: 514 patients with chronic liver disease who consecutively underwent percutaneous liver biopsy were included in the study. All patients had a Doppler-US examination and LSM with Virtual Touch Quantification (VTQ) on the same day as a liver biopsy. A subset of 326 patients also had LSM with 2D shear wave elastography (SSI). Severe fibrosis was defined as Metavir F ≥ 3 on liver biopsy. RESULTS: Multivariate analysis confirmed our three simple Doppler-US signs (liver surface irregularity, splenomegaly ≥110 mm, and demodulation of hepatic veins) as independently associated with severe fibrosis. The presence of at least one of these three signs showed 85.6% sensitivity and 36.1% specificity for the diagnosis of severe liver fibrosis. Using VTQ (≥1.59 m/s) where there was a positive Doppler-US sign increased the specificity to 80.8%, at the cost of a decrease in sensitivity (73.7%). Similar results were obtained with SSI (≥9.5 kPa), with 73.3% specificity and 81.5% sensitivity. CONCLUSION: Elastography improves the accuracy of Doppler-US in the detection of severe fibrosis. This two-step procedure will help radiologists to accurately identify patients who need to be referred to specialist hepatologists during routine Doppler-US examinations.


Assuntos
Técnicas de Imagem por Elasticidade/instrumentação , Cirrose Hepática/diagnóstico por imagem , Ultrassonografia Doppler/instrumentação , Adulto , Idoso , Angiografia/métodos , Biópsia/métodos , Técnicas de Imagem por Elasticidade/métodos , Feminino , Veias Hepáticas/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Sensibilidade e Especificidade , Esplenomegalia/patologia
18.
Acta Clin Croat ; 57(2): 71-81, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30431721

RESUMO

In the liver, there are many vascular variants, which are important in liver surgery, the presence of accessory right hepatic veins (aRHVs) in particular. Th eir frequency, number and diameter vary considerably. Detailed imaging diagnostics with computed tomography (CT) should be undertaken before surgery. Th e aim of our study was to examine the characteristics of aRHVs and their demographic correlations. Th e study included data on 188 patients that underwent CT examination of the abdomen with contrast media, 103 men (54.8%) men and 85 (45.2%) women, mean age 63.1±14.3 (range, 21-94) years. Th e measurements of hepatic veins were carried out on CT images, which were obtained from the Clinical Institute of Radiology, University Medical Centre of Ljubljana. Forty-fi ve of 142 patients had at least one aRHV: one aRHV in 37 (26.1%) cases, two aRHVs in seven (4.9%) cases, and three aRHVs in one (0.7%) case. Th e incidence of aRHV was between 24% and 39.3% (mean, 31.7%) and of more than one aRHV between 2.3% and 10.3% with 95% confi dence interval (CI). Based on the test of proportions, the proportion of cases with inferior aRHV of at least 7 mm was between 7.2% and 18.1% with 95% CI. Th e mean distance between the aRHV and the main RHV confl uences into the inferior vena cava was 3.73 cm (between 3.32 cm and 4.13 cm, 95% CI). Th e proportion of cases with confl uence distance of at least 4 cm was between 21.6% and 49.5% in cases with at least one aRHV. In cases with more than one aRHV, the distance between the middle aRHV and the main RHV ranged from 1.90 cm to 4.32 cm (95% CI). Th e T-test of independent samples showed no eff ect of age on the incidence of accessory veins (p=0.18), and the test of diff erences of interests showed no impact of sex (p=0.75). Evaluation of the incidence and diameter of aRHVs is of great importance for safe surgical procedure. Th eir presence can change the surgeon's decision in 10%-20% of cases when employing appropriate imaging technique. CT examination, which is easily accessible and minimally invasive for patients, was successful in only 80% cases, when using standard protocol for CT scanning.


Assuntos
Veias Hepáticas , Fígado , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Veias Hepáticas/diagnóstico por imagem , Humanos , Fígado/irrigação sanguínea , Fígado/cirurgia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
Medicine (Baltimore) ; 97(43): e12944, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30412110

RESUMO

This study aimed to evaluate the long-term efficacy and safety of percutaneous transhepatic balloon angioplasty (PTBA) and transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the treatment of Budd-Chiari syndrome (BCS) with hepatic veins involvement. Between June 2008 and August 2016, a total of 60 BCS patients with hepatic vein involvement in our department were enrolled in this study. Thirty-three cases underwent hepatic vein balloon angioplasty in PTBA Group and 27 cases underwent TIPSS. Data were retrospectively collected, and follow-up observations were performed. TIPSS Group showed significantly higher thrombotic/segmental obstruction and peripheral stenosis/obstruction compared with PTBA Group. The success rates were 93.9% and 100.0% in PTBA Group and TIPSS Group, respectively. The mean portal vein pressure decreased significantly after stenting. Except for 1 patient died from repeated hemorrhage, other sever complications had not been observed in both group. Twenty-six patients and 21 patients were clinically cured in PTBA Group and TIPSS Group, respectively. The primary patency rates were 89.7%, 79.3%, and 79.3% for short-term, mid-term and longterm in PTBA Group, which were significantly higher than TIPSS Group for long-term follow up. The second patency rates were 100.0%, 96.6% and 96.6% for short-term, mid-term and long-term in PTBA Group, which were similar to TIPSS Group (P = 1.0000). In conclusion, PTBA and TIPSS are safe and effective in the treatment of BCS with hepatic veins involvement, with an excellent long-term patency rate of hepatic vein and TIPSS shunt. TIPSS can be used to treat patients with all 3 hepatic veins lesion and failure PTBA.


Assuntos
Angioplastia com Balão/métodos , Síndrome de Budd-Chiari/terapia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Adolescente , Adulto , Idoso , Anticoagulantes/administração & dosagem , Síndrome de Budd-Chiari/classificação , Síndrome de Budd-Chiari/complicações , Angiografia por Tomografia Computadorizada , Feminino , Heparina/administração & dosagem , Veias Hepáticas/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia , Adulto Jovem
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