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Transjugular portal vein puncture is considered the riskiest step in TIPS creation with possible incidence of portal vein puncture-related complications (PVPC). The Colapinto and the Rösch-Uchida needle sets are two different needle sets currently available. To date, there have been no randomized control trials or systematic reviews which compare the incidence of PVPC when using the two different needle sets. The aim of this literature review is to assess the rate of PVPC associated with the different needle sets used in the creation of TIPS. From the described search, 1500 articles were identified and 34 met the inclusion criteria. Outcome measured was the prevalence of PVPC using the different needle sets. Overall 212 (3.6%) PVPC were reported in 5865 patients; 142 (3.5%) reported in 4000 cases using the Rösch-Uchida set and 70 (3.7%) in 1865 patients using the Colapinto set (p = 0.69). PVPC in TIPS creation are not related to the choice of needle set used in the procedure. To our knowledge, this is the first review of its kind, the results of which support the theory that while the rate of PVPC is influenced by many factors, choice of needle set does not seem to be one of them.
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Agulhas , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Complicações Pós-Operatórias/etiologia , Punções/efeitos adversos , Desenho de Equipamento , Humanos , Veia PortaRESUMO
BACKGROUND: This study aims to evaluate radiation exposure in patients with complete portal vein thrombosis (CPVT) or portal cavernoma (PC) undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation using real-time ultrasound guidance for portal vein targeting. MATERIALS AND METHODS: This is a single institution retrospective analysis. Between August 2009 and September 2018, TIPS was attempted in 49 patients with CPVT or PC. Radiation exposure (dose area product [DAP], air KERMA (AK) and fluoroscopy time [FT]), technical success, clinical success, complications and survival were analyzed. RESULTS: In total, 29 patients had CPVT and 20 patients had PC. 41/49 patients had cirrhosis. TIPS indications were refractory ascites (n = 25), variceal bleeding (n = 16) and other (n = 8). TIPS was successfully placed in 94% (46/49) of patients via a transjugular approach alone (n = 40), a transjugular/transhepatic approach (n = 5) and a transjugular/transsplenic approach (n = 1). Median DAP was 261 Gy * cm2 (range 29-950), median AK was 0.2 Gy (range 0.05-0.5), and median FT was 28.2 min (range 7.7-93.7). Mean portosystemic pressure gradient decreased from 16.8⯠± â¯5.1 mmHg to 7.5⯠± â¯3.3â¯mmHg (P < â¯0.01). There were no major procedural complications. Overall clinical success was achieved in 77% of patients (mean follow-up of 21.1 months). Encephalopathy was observed in 16 patients (34%), grade II-III encephalopathy in 7 patients (15%). TIPS revision was performed in 15 patients (32%). Overall survival rate was 75%. CONCLUSION: In our experience, the use of real-time ultrasound guidance allowed the majority of the TIPS to be performed via a transjugular approach alone with a reasonably low radiation exposure considering the high technical difficulties of the selected cohort of patients with CVPT or PC.
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Hemangioma Cavernoso/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Derivação Portossistêmica Transjugular Intra-Hepática , Exposição à Radiação , Ultrassonografia de Intervenção , Trombose Venosa/diagnóstico por imagem , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Fluoroscopia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/cirurgia , Hemangioma Cavernoso/cirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose Venosa/cirurgiaRESUMO
We describe the use of an Amplatzer Vascular Plug (AVP) II for embolizing a large high-flow splenic arteriovenous fistula and an aneurysm in a young patient. This patient presented to our center with persistent mild abdominal discomfort, 5 years after open splenectomy. Contrast-enhanced computed tomography angiography showed the presence of a fistula between the splenic arterial and splenic venous remnants and a resultant fusiform aneurysmal dilatation of the residual splenic vein. We decide to embolize the splenic artery with a 12-mm diameter AVP II with an oversizing by 70% of the vessel diameter. Celiac angiography performed 5 min postembolization revealed complete obliteration of the splenic artery and closure of the arteriovenous fistula. The overall procedure time was 40 min, and overall radiation exposure was 32 Gy cm(2) (dose-area product).
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Aneurisma/terapia , Fístula Arteriovenosa/terapia , Embolização Terapêutica/instrumentação , Esplenectomia/efeitos adversos , Artéria Esplênica/fisiopatologia , Veia Esplênica/fisiopatologia , Adulto , Aneurisma/diagnóstico , Aneurisma/etiologia , Aneurisma/fisiopatologia , Angiografia Digital , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Doses de Radiação , Exposição à Radiação , Fluxo Sanguíneo Regional , Artéria Esplênica/diagnóstico por imagem , Veia Esplênica/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Diagnosis of hepatocellular carcinoma (HCC) is centered on wash-in of contrast during the arterial phase followed by washout during the portal or delayed venous phase. Nodules showing hypointensity on the hepatobiliary phase are also likely to represent HCC, however, the role of this phase is not yet established. PURPOSE: To investigate the role of the hepatobiliary phase on Gadobenate dimeglumine (Gd-BOPTA) magnetic resonance imaging (MRI) in characterizing HCCs lacking the typical arterial enhancement and venous washout. MATERIAL AND METHODS: Ninety-seven cirrhotic patients (78 men, 19 women; mean age, 58.5 years) who underwent liver transplantation (2004-2012) and Gd-BOPTA enhanced MRI within 3 months of surgery were retrospectively reviewed. A nodule-by-nodule analysis was performed, followed by liver explant correlation. Statistical analysis was then performed by a biostatistician using commercially available software. RESULTS: A total of 193 HCCs were found in 97 liver explants, of which 24.9% (48/193) were not detectable on imaging. The 145 HCCs seen on imaging showed the typical wash-in/washout pattern (Pattern A) in 46.9% (68/145), arterial enhancement without washout (Pattern B) in 37.9% (55/145), and hypovascularity on arterial and venous sequences (Pattern C) in 15.2% (22/145). Pattern A was exclusive to HCC. Twenty-three of the 55 HCCs showing Pattern B were also hypointense on the hepatobiliary phase (Pattern B1). Combining Pattern B1 with Pattern A raises the sensitivity of HCC characterization from 46.9% to 62.8% (P = 0.007), with no significant compromise on specificity. CONCLUSION: When coupled with Pattern A, Pattern B1 augments sensitivity of HCC characterization with no significant compromise on the specificity.
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Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Meios de Contraste , Feminino , Humanos , Cirrose Hepática/diagnóstico por imagem , Transplante de Fígado , Masculino , Meglumina/análogos & derivados , Pessoa de Meia-Idade , Compostos Organometálicos , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To determine whether the use of a low-dose acquisition protocol (LDP) in digital subtraction angiography during transjugular intrahepatic portosystemic shunt (TIPS) creation/revision results in significant reduction of patient radiation exposure and adequate image quality, as compared to a default reference standard-dose acquisition protocol (SDP). METHODS: Two angiographic runs were performed during TIPS creation/revision: the first following catheterization of the portal venous system and the second after stent deployment/angioplasty. Constant field of view, object to image-detector distance, and source to image-receptor distance were maintained in each patient during the two angiographic runs. 17 consecutive adult patients who underwent TIPS creation (n = 11) or TIPS revision (n = 6) from December 2013 to March 2014 were considered eligible for this single centre prospective study. In each patient, the LDP and the SDP were used in a random order for the two runs, with each patient serving as his/her own control. The dose-area product (DAP) was calculated for each image and compared. Image quality was graded by two interventional radiologists other than the operator. RESULTS: In all runs acquired with the LDP, image quality was considered adequate for a successful procedural outcome. The DAP per image of the LDP was numerically inferior as compared to the DAP per image of the SDP in all patients. The mean reduction in DAP per image was 75.24% ± 5.7% (p < 0. 001). CONCLUSION: Radiation exposure during TIPS creation/revision was significantly reduced by selecting a LDP in our flat-panel detector-based system, while maintaining adequate image quality.
Assuntos
Angiografia Digital , Derivação Portossistêmica Transjugular Intra-Hepática , Doses de Radiação , Idoso , Protocolos Clínicos , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade , Imagens de Fantasmas , Estudos Prospectivos , Radiologia Intervencionista , ReoperaçãoRESUMO
BACKGROUND: Ultrasound-guided central venous puncture and fluoroscopic guidance during central venous catheter (CVC) positioning optimizes technical success and lowers the complication rates in children, and is therefore considered standard practice. OBJECTIVE: The purpose of this study was to compare the radiation exposure levels recorded during CVC placement in children weighing less than 10 kg in procedures performed using an image intensifier-based angiographic system (IIDS) to those performed in a flat-panel detector-based interventional suite (FPDS). MATERIALS AND METHODS: A retrospective review of 96 image-guided CVC placements, between January 2008 and October 2013, in 49 children weighing less than 10 kg was performed. Mean age was 8.2 ± 4.4 months (range: 1-22 months). Mean weight was 7.1 ± 2.7 kg (range: 2.5-9.8 kg). The procedures were classified into two categories: non-tunneled and tunneled CVC placement. RESULTS: Thirty-five procedures were performed with the IIDS (21 non-tunneled CVC, 14 tunneled CVC); 61 procedures were performed with the FPDS (47 non-tunneled CVC, 14 tunneled CVC). For non-tunneled CVC, mean DAP was 113.5 ± 126.7 cGy cm(2) with the IIDS and 15.9 ± 44.6 cGy · cm(2) with the FPDS (P < 0.001). For tunneled CVC, mean DAP was 84.6 ± 81.2 cGy · cm(2) with the IIDS and 37.1 ± 33.5 cGy cm(2) with the FPDS (P = 0.02). CONCLUSION: The use of flat-panel angiographic equipment reduces radiation exposure in small children undergoing image-guided CVC placement.
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Cateterismo Venoso Central/métodos , Doses de Radiação , Intensificação de Imagem Radiográfica/instrumentação , Radiografia Intervencionista/métodos , Ecrans Intensificadores para Raios X , Angiografia , Feminino , Fluoroscopia , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVES: To evaluate the diagnostic efficacy of different oral contrast media (OCM) for abdominopelvic CT examinations performed for follow-up general oncological indications. The objectives were to establish anatomical image quality criteria for abdominopelvic CT; use these criteria to evaluate and compare image quality using positive OCM, neutral OCM and no OCM; and evaluate possible benefits for the medical imaging department. METHODS: Forty-six adult patients attending a follow-up abdominopelvic CT for general oncological indications and who had a previous abdominopelvic CT with positive OCM (n = 46) were recruited and prospectively placed into either the water (n = 25) or no OCM (n = 21) group. Three radiologists performed absolute visual grading analysis (VGA) to assess image quality by grading the fulfilment of 24 anatomical image quality criteria. RESULTS: Visual grading characteristics (VGC) analysis of the data showed comparable image quality with regards to reproduction of abdominal structures, bowel discrimination, presence of artefacts, and visualization of the amount of intra-abdominal fat for the three OCM protocols. CONCLUSION: All three OCM protocols provided similar image quality for follow-up abdominopelvic CT for general oncological indications. KEY POINTS: ⢠Positive oral contrast media are routinely used for abdominopelvic multidetector computed tomography ⢠Experimental study comparing image quality using three different oral contrast materials ⢠Three different oral contrast materials result in comparable CT image quality ⢠Benefits for patients and medical imaging department.
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Neoplasias Abdominais/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Iohexol/administração & dosagem , Tomografia Computadorizada Multidetectores/métodos , Neoplasias Pélvicas/diagnóstico por imagem , Pelve/diagnóstico por imagem , Radiografia Abdominal/métodos , Administração Oral , Adulto , Humanos , Curva ROC , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
Hepatic artery thrombosis is a major problem after pediatric liver transplantation. Ischemia caused by hepatic artery thrombosis results in severe biliary and parenchymal damage and is associated with high rates of graft loss and mortality. We present a case-based pictorial essay to illustrate the role of minimally invasive treatment in the prompt management of acute hepatic artery thrombosis, and the associated biliary complications.
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Procedimentos Endovasculares/métodos , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Trombose/diagnóstico por imagem , Trombose/etiologia , Doença Aguda , Adolescente , Feminino , Humanos , Lactente , Masculino , Resultado do Tratamento , UltrassonografiaRESUMO
PURPOSE: Patient-specific protocol optimisation in abdomino-pelvic Computed Tomography (CT) requires measurement of body habitus/size (BH), sensitivity-specificity (surrogates image quality (IQ) metrics) and risk (surrogates often dose quantities) (RD). This work provides an updated inventory of metrics available for each of these three categories of optimisation variables derivable directly from patient measurements or images. We consider objective IQ metrics mostly in the spatial domain (i.e., those related directly to sharpness, contrast, noise quantity/texture and perceived detectability as these are used by radiologists to assess the acceptability or otherwise of patient images in practice). MATERIALS AND METHODS: The search engine used was PubMed with the search period being 2010-2024. The key words used were: 'comput* tomography', 'CT', 'abdom*', 'dose', 'risk', 'SSDE', 'image quality', 'water equivalent diameter', 'size', 'body composition', 'habit*', 'BMI', 'obes*', 'overweight'. Since BH is critical for patient specific optimisation, articles correlating RD vs BH, and IQ vs BH were reviewed. RESULTS: The inventory includes 11 BH, 12 IQ and 6 RD metrics. 25 RD vs BH correlation studies and 9 IQ vs BH correlation studies were identified. 7 articles in the latter group correlated metrics from all three categories concurrently. CONCLUSIONS: Protocol optimisation should be fine-tuned to the level of the individual patient and particular clinical query. This would require a judicious choice of metrics from each of the three categories. It is suggested that, for increased utility in clinical practice, more future optimisation studies be clinical task based and involve the three categories of metrics concurrently.
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ABSTRACT: Neurofibromatosis type (NF-1) is an autosomal dominant disorder characterized predominantly by neurocutaneous manifestations. Involvement of the gastrointestinal tract is uncommon but is associated with a significant risk of malignancy. There are a handful of case reports linking NF-1 with pancreatic neuroendocrine tumors; these include gastrin-secreting variants with the attendant Zollinger-Ellison syndrome. We present the case of a 52-year-old lady who presented with recurrent peptic ulceration and diarrhea. Serum gastrin levels were elevated and magnetic resonance imaging demonstrated the presence of a pancreatic lesion with multiple liver metastases. The lesion was moderately fludeoxyglucose avid on positron emission tomography-computed tomography. Endoscopic ultrasonography-guided sampling revealed the presence of synaptophysin positive neuroendocrine cells with positive gastrin immunostaining. A conservative approach was adopted, and the patient's symptoms improved on proton pump inhibitors. Zollinger-Ellison syndrome is an important condition, which should be kept in mind in the patient with NF-1 who presents with recurrent peptic ulceration and diarrhea. The emerging association between these 2 conditions is being examined on a cellular and immunohistochemical level.
Assuntos
Gastrinoma , Tumores Neuroendócrinos , Neurofibromatose 1 , Neoplasias Pancreáticas , Úlcera Péptica , Síndrome de Zollinger-Ellison , Diarreia , Feminino , Gastrinoma/complicações , Gastrinas , Humanos , Pessoa de Meia-Idade , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/genética , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico , Neurofibromatose 1/genética , Neoplasias Pancreáticas/diagnóstico , Síndrome de Zollinger-Ellison/complicações , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/patologiaRESUMO
PURPOSE: Calculation of the Size Specific Dose Estimate (SSDE) requires accurate delineation of the skin boundary of patient CT slices. The AAPM recommendation for SSDE evaluation at every CT slice is too time intensive for manual contouring, prohibiting real-time or bulk processing; an automated approach is therefore desirable. Previous automated delineation studies either did not fully disclose the steps of the algorithm or did not always manage to fully isolate the patient. The purpose of this study was to develop a validated, freely available, fast, vendor-independent open-source tool to automatically and accurately contour and calculate the SSDE for the abdomino-pelvic region for entire studies in real-time, including flagging of patient-truncated images. METHODS: The Python tool, CTContour, consists of a sequence of morphological steps and scales over multiple cores for speed. Tool validation was achieved on 700 randomly selected slices from abdominal and abdomino-pelvic studies from public datasets. Contouring accuracy was assessed visually by four medical physicists using a 1-5 Likert scale (5 indicating perfect contouring). Mean SSDE values were validated via manual calculation. RESULTS: Contour accuracy validation produced a score of four of five for 98.5 % of the images. A 300 slice exam was contoured and truncation flagged in 6.3 s on a six-core laptop. CONCLUSIONS: The algorithm was accurate even for complex clinical scenarios and when artefacts were present. Fast execution makes it possible to automate the calculation of SSDE in real time. The tool has been published on GitHub under the GNU-GPLv3 license.
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Abdome , Tomografia Computadorizada por Raios X , Abdome/diagnóstico por imagem , Pelve/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada por Raios X/métodosRESUMO
Liver metastases from neuroendocrine tumours (NETs) are usually seen on cross-sectional imaging at presentation. In such cases, curative surgical resection is usually not possible given that most patients have bilobar disease. Various locoregional approaches are now widely available that enable local control of disease and management of systemic symptoms. These include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), selective internal radiotherapy and thermal ablation. We describe a rare case of hepatic necrosis after TAE in a 61-year-old woman with a metastatic NET. Cross-sectional imaging showed extensive necrosis affecting segments VII and VIII of the liver. This occurred secondary to thrombosis in the portal vein branches to these segments, confirmed on a Doppler ultrasound scan. The mechanism of portal vein thrombosis after TAE could be due to the presence of occult arterioportal anastomoses. These allow transit of the embolizing agents into the portal vein branches supplying the treated segments and subsequent thrombosis. LEARNING POINTS: Hepatic necrosis is a very rare but significant complication of TAE. The incidence of this complication after TAE has not yet been reported.Hepatic necrosis may be mimicked by the more commonly encountered post-embolization syndrome (PES). Hepatic necrosis should be suspected when symptoms are prolonged, or if the patient exhibits any form of deterioration. Prompt cross-sectional imaging is crucial in establishing diagnosis.Thorough supportive management is key in the setting of liver injury or failure. Sepsis should be treated aggressively with regular blood cultures and specialist input should be sought for optimization of antibiotic regimes.
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We describe the case of a 77-year-old woman, presenting with non-specific epigastric pain. Physical examination and subsequent imaging revealed the presence of a large mass in the right liver lobe. This was shown to be a leiomyosarcoma on biopsy histology. Further investigation confirmed this to be a primary hepatic leiomyosarcoma with no evidence of metastases. The patient underwent successful surgical resection. She is currently under imaging follow-up, with no evidence of disease recurrence.
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Hepatectomia , Laparoscopia , Leiomiossarcoma/cirurgia , Neoplasias Hepáticas/cirurgia , Idoso , Feminino , Humanos , Leiomiossarcoma/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagemRESUMO
European Directive 2013/59/EURATOM requires the establishment and use of diagnostic reference levels (DRLs) for diagnostic and interventional procedures. The purpose of this study was to establish local DRLs for a major tertiary public hospital. As the hospital is the only such hospital in Malta, the same data collected for setting local DRLs can also be used for setting national DRLs, making local DRLs de facto national DRLs. A retrospective survey of cumulative kerma-area product (KAP) and fluoroscopy time data from the cardiac catheterisation laboratory and interventional radiology suites was carried out. The effect of system upgrades on cumulative KAP was also assessed. Local DRLs were set for common cardiology and interventional radiology procedures. All DRLs compare favourably with those in European literature. A Philips Allura Clarity upgrade to the cardiac catheterisation laboratories led to significant reductions in cumulative KAP (p ⪠0.05) for most procedures.
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Cardiologia , Radiologia Intervencionista , Fluoroscopia , Malta , Doses de Radiação , Radiografia Intervencionista , Valores de Referência , Estudos RetrospectivosRESUMO
The hemangioma is the most common solid lesion of the liver. Therefore, radiologists must know the typical and atypical imaging findings of this lesion in order to reach a correct diagnosis and avoid diagnostic errors. However, only few papers have comprehensively described the entire spectrum of atypical and uncommon imaging features. In this updated review, we provide the imaging features of hepatic hemangioma, in both typical and atypical forms, as well as its association with abnormalities in the adjacent hepatic parenchyma and other hepatic lesions, and its complications.
Assuntos
Hemangioma/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Diagnóstico Diferencial , Hemangioma/complicações , Hemangioma/patologia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologiaRESUMO
Our objective is to retrospectively evaluate the effective dose (E) of operators performing pediatric Hepatobiliary Minimally Invasive Procedures (HMIP). Between October 2015 and December 2017, 58 consecutive HMIP were performed on 26 children weighing less than 20 kg (mean 12.3 kg, median 13 kg, range 2.4-20 kg). About 31 vascular procedures (n = 9 hepatic venograms with/without stenting; n = 9 retrograde wedge portography; n = 8 transhepatic portography with angioplasty and/or stenting and n = 5 hepatic arteriography/embolization) and 27 non-vascular procedures (n = 6 percutaneous transhepatic biliary drainage (PTBD); n = 3 bilioplasty; n = 15 biliary catheter change and n = 3 cholangiogram) were performed. Electronic personal dosimeters were used to measure radiation doses to the interventional radiologist, radiographer and anesthesia nurse. The results shows the highest mean effective dose: interventional radiologist's in PTBD (1.18 µSv); radiographer's in hepatic veins phlebography with/without stenting (0.25 µSv) and nurse's in hepatic arteriography/embolization (0.26 µSv). Operators' E can vary depending on the complexity of procedure performed and the position of the operators within the angiosuite.
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Doenças do Sistema Digestório/diagnóstico por imagem , Doenças do Sistema Digestório/terapia , Exposição Ocupacional/análise , Doses de Radiação , Radiografia Intervencionista , Radiologistas , Peso Corporal , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Estudos RetrospectivosRESUMO
Fibropolycystic liver diseases, also known as ductal plate malformations, are a group of associated congenital disorders resulting from abnormal development of the biliary ductal system. These disorders include congenital hepatic fibrosis, biliary hamartomas, polycystic liver disease, choledochal cysts and Caroli disease. Recently, it has been thought to include biliary atresia in this group of diseases, because ductal plate malformations could be implicated in the pathogenesis of this disease. Concomitant associated renal anomalies can also be present, such as autosomal recessive polycystic kidney disease (ARPKD), medullary sponge kidney and nephronophthisis. These disorders can be clinically silent or can cause abnormalities such as cholangitis, portal hypertension, gastrointestinal bleeding and infections. The different types of ductal plate malformations show typical findings at magnetic resonance (MR) imaging. A clear knowledge of the embryology and pathogenesis of the ductal plate plays a pivotal role to understand the characteristic imaging appearances of these complex diseases. Awareness of these MR imaging findings is central to the detecting and differentiating between various fibropolycystic liver diseases and is important to direct appropriate clinical management and prevent misdiagnosis.
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Doença de Caroli/diagnóstico por imagem , Cistos/diagnóstico por imagem , Doenças Genéticas Inatas/diagnóstico por imagem , Cirrose Hepática/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Diagnóstico Diferencial , HumanosRESUMO
Budd-Chiari syndrome (BCS) is a disorder with numerous causes that is a result of hepatic outflow obstruction, in the absence of right heart failure or constrictive pericarditis. Acute Budd-Chiari syndrome is uncommon and clinically characterized by ascites, hepatomegaly, and hepatic insufficiency. In the majority of cases, patients present with chronic BCS, showing a dysmorphic liver disease with variable fibrosis deposition. In chronic Budd-Chiari syndrome, hepatocellular carcinoma (HCC) and benign regenerative nodules (called large regenerative nodules or FNH-like lesions) have been described in the literature. Very few studies have reported magnetic resonance imaging (MRI) findings about these nodules, using hepatobiliary contrast medium. The aim of our review is to describe the magnetic resonance imaging findings of hepatic regenerative nodules in BCS, with emphasis on the hepatobiliary phase, and to compare the imaging features of benign nodules with those of HCC.
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Síndrome de Budd-Chiari/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Fígado/patologia , Imageamento por Ressonância Magnética , Síndrome de Budd-Chiari/patologia , Carcinoma Hepatocelular/patologia , Meios de Contraste , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
Percutaneous microwave ablation of liver tumours is a well-established technique that has been proven to be effective in the curative and palliative treatment of small volume primary and secondary liver tumours. Microwave ablation is designed to achieve larger areas of necrosis compared to radiofrequency ablation and has a good safety profile among liver tumour treatments. Mortality is unreported and major complications are rare. Knowledge of potential complications is essential for interventional radiologists performing liver ablation in order to reduce patient morbidity. The aim of this review is to illustrate major complications post microwave ablation in a pictorial format as well as a discussion on how best to avoid these complications.