RESUMO
OBJECTIVE: To analyse the impact of the COVID-19 pandemic on a centralized specialist kidney cancer care pathway. MATERIALS AND METHODS: We conducted a retrospective analysis of patient and pathway characteristics including prioritization strategies at the Specialist Centre for Kidney Cancer located at the Royal Free London NHS Foundation Trust (RFH) before and during the surge of COVID-19. RESULTS: On 18 March 2020 all elective surgery was halted at RFH to redeploy resources and staff for the COVID-19 surge. Prioritizing of patients according to European Association of Urology guidance was introduced. Clinics and the specialist multidisciplinary team (SMDT) meetings were maintained with physical distancing, kidney surgery was moved to a COVID-protected site, and infection prevention measurements were enforced. During the 7 weeks of lockdown (23 March to 10 May 2020), 234 cases were discussed at the SMDT meetings, 53% compared to the 446 cases discussed in the 7 weeks pre-lockdown. The reduction in referrals was more pronounced for small and asymptomatic renal masses. Of 62 low-priority cancer patients, 27 (43.5%) were deferred. Only one (4%) COVID-19 infection occurred postoperatively, and the patient made a full recovery. No increase in clinical or pathological upstaging could be detected in patients who underwent deferred surgery compared to pre-COVID practice. CONCLUSION: The first surge of the COVID-19 pandemic severely impacted diagnosis, referral and treatment of kidney cancer at a tertiary referral centre. With a policy of prioritization and COVID-protected pathways, capacity for time-sensitive oncological interventions was maintained and no immediate clinical harm was observed.
Assuntos
COVID-19/prevenção & controle , Carcinoma de Células Renais/terapia , Neoplasias Renais/terapia , Equipe de Assistência ao Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , COVID-19/epidemiologia , Institutos de Câncer/organização & administração , Institutos de Câncer/estatística & dados numéricos , Carcinoma de Células Renais/patologia , Progressão da Doença , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Neoplasias Renais/patologia , Estadiamento de Neoplasias , Nefrectomia/estatística & dados numéricos , Seleção de Pacientes , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Tempo para o Tratamento , Conduta Expectante/estatística & dados numéricosRESUMO
OBJECTIVES: To study the natural history of renal oncocytomas and address indications for intervention by determining how growth is associated with renal function over time, the reasons for surgery and ablation, and disease-specific survival. PATIENTS AND METHODS: The study was conducted in a retrospective cohort of consecutive patients with renal oncocytoma on active surveillance reviewed at the Specialist Centre for Kidney Cancer at the Royal Free London NHS Foundation Trust (2012 to 2019). Comparison between groups was performed using Mann-Whitney U-tests and chi-squared tests. A mixed-effects model with a random intercept for patient was used to study the longitudinal association between tumour size and estimated glomerular filtration rate (eGFR). RESULTS: Longitudinal data from 98 patients with 101 lesions were analysed. Most patients were men (68.3%) and the median (interquartile range [IQR]) age was 69 (13) years. The median (IQR) follow-up was 29 (26) months. Most lesions were small renal masses, and 24% measured over 4 cm. Over half (64.4%) grew at a median (IQR) rate of 2 (4) mm per year. No association was observed between tumour size and eGFR over time (P = 0.871). Nine lesions (8.9%) were subsequently treated. Two deaths were reported, neither were related to the diagnosis of renal oncocytoma. CONCLUSION: Natural history data from the largest active surveillance cohort of renal oncocytomas to date show that renal function does not seem to be negatively impacted by growing oncocytomas, and confirms clinical outcomes are excellent after a median follow-up of over 2 years. Active surveillance should be considered the 'gold standard' management of renal oncocytomas up to 7cm.
Assuntos
Adenoma Oxífilo/patologia , Adenoma Oxífilo/fisiopatologia , Taxa de Filtração Glomerular , Neoplasias Renais/patologia , Neoplasias Renais/fisiopatologia , Carga Tumoral , Conduta Expectante , Adenoma Oxífilo/complicações , Adenoma Oxífilo/terapia , Idoso , Idoso de 80 Anos ou mais , Criocirurgia , Feminino , Seguimentos , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/terapia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
BACKGROUND: Small intestinal neuroendocrine tumours (SI NETs) represent 30-50% of small bowel neoplasms and often present at an advanced stage. To date, there is relatively limited literature regarding prognostic factors affecting overall survival (OS) in stage IV disease. In addition, the prevalence of mesenteric fibrosis (MF) in SI NETs and its effect on OS have not been sufficiently explored in the literature. AIM: The primary aim of this study was to perform a large-scale survival analysis in an institutional cohort of 387 patients with metastatic (stage IV) SI NETs. The secondary aim was to provide epidemiological information regarding the prevalence of MF and to evaluate its effect on OS. RESULTS: The median OS was 101 months (95% CI 84, 118). Age > 65 years, mesenteric metastases with and without desmoplasia, liver metastases, carcinoid heart disease (CHD) and bone metastases were associated with a significantly shorter OS, while primary tumour resection was predictive of a longer OS. The benefit of surgical resection was limited to symptomatic patients. MF was present in approximately 50% of patients with mesenteric lymphadenopathy. Elevated urinary 5-HIAA levels correlated strongly with the presence of CHD (p < 0.001) and to a lesser extent (p = 0.02) with MF. MF and CHD did not usually co-exist, suggesting that different mechanisms are likely to be involved in the development of these fibrotic complications. CONCLUSIONS: This study has identified specific prognostic factors in a large cohort of 387 patients with advanced SI NETs and has provided useful epidemiological data regarding carcinoid-related fibrotic complications.
Assuntos
Neoplasias Intestinais/patologia , Intestino Delgado/patologia , Tumores Neuroendócrinos/secundário , Idoso , Neoplasias Ósseas/secundário , Feminino , Fibrose/patologia , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
BACKGROUND: The antiproliferative activity of octreotide LAR in neuroendocrine tumours (NETs) has been demonstrated by small retrospective studies and confirmed by a prospective phase III trial (PROMID). However, there are limited data about the duration and predictors of response. The aim of our retrospective study was to determine the time to radiological progression (TTRP) of disease and the factors that were associated with better response. METHODS: A total of 254 treatment naïve patients with advanced NETs and positive somatostatin receptor scintigraphy were included. Mean follow-up period was 42 months. RESULTS: The location of primary was in the small bowel in 204, pancreas in 22, lungs in 14, rectum in 7 and unknown in 7 patients. Most tumours were well-differentiated, G1 (58%) and G2 (23%). The majority of patients commenced octreotide LAR due to functional symptoms (57%), radiological progression (10%) or in the presence of asymptomatic and stable disease on the basis of data from the PROMID trial (18.5%). Partial response occurred in 5%. For all patients, the median TTRP was 37 months (95% confidence interval, CI: 32-52 months). There was a statistically significant shorter TTRP in patients with pancreatic tumours, liver metastases and intermediate grade tumours. Extremely raised (>10 times the upper limit of normal) baseline chromogranin A levels were associated with an unfavourable outcome. In contrast, male sex, carcinoid heart disease and initiation of treatment in the presence of stable disease were predictive of a better response. Age, extra-hepatic metastases, presence of mesenteric desmoplasia, previous resection and functional status of the primary tumour did not affect response. CONCLUSIONS: The duration of the antiproliferative effect of octreotide LAR seems to be longer than previously reported. This study has identified several predictors of response in a large cohort of patients with NETs on somatostatin analogue therapy.
Assuntos
Antineoplásicos Hormonais/uso terapêutico , Proliferação de Células/efeitos dos fármacos , Tumores Neuroendócrinos/tratamento farmacológico , Octreotida/uso terapêutico , Idoso , Antineoplásicos Hormonais/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tumores Neuroendócrinos/patologia , Octreotida/farmacologia , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Anal carcinoma is an important but rare condition, managed in specialist centres. Both endoanal ultrasound and magnetic resonance imaging (MRI) can be used in the locoregional staging and follow-up of patients with anal cancer, and both may assist in treatment planning and prognosis. Recent guidelines published by the European Society for Medical Oncology have recommended MRI as the technique of choice for assessment of locoregional disease. This paper describes the techniques for both endoanal ultrasound and MRI, and compares the relative merits and disadvantages of each in the local assessment of anal carcinoma.
Assuntos
Neoplasias do Ânus/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Estadiamento de Neoplasias/métodos , Canal Anal/patologia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Oncologia/métodos , Prognóstico , Radiografia , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVE: The objectives of the study were to compare the operative assessment of residual disease with the postoperative computed tomography (CT) findings in patients with ovarian cancer who underwent primary surgical cytoreduction or interval debulking surgery to residual disease 1 cm or less and to assess the effect of potential prognostic factors on patient survival. METHODS: Patients scheduled for surgery and with an available postoperative CT were eligible for the study. Images were retrospectively analyzed in consensus by 2 radiologists.A 5-point qualitative scoring system was used to evaluate the CT findings (1 = tumor definitely absent, 2 = tumor probably absent, 3 = tumor possibly present, 4 = tumor probably present, 5 = tumor definitely present). RESULTS: Between September 2005 and December 2008, 206 consecutive patients were enrolled; 51 were eligible. In 30 cases (59%), the postoperative CT findings correlated with the surgeon's assessment of residual disease. For the univariate analyses, the only significant prognostic factors associated with overall survival were no residual disease versus residual disease of less than 1 cm as assessed by the surgeon (hazard ratio [HR], 3.06; 95%confidence interval [CI], 1.29--7.27; P = 0.011) and no residual disease versus residual disease greater than 1 cm on CT (HR, 2.57; 95% CI, 1.02--6.48; P = 0.045). The interaction of surgical residual disease and stage 3 was significant (HR, 3.40; 95% CI, 1.42--8.16;P = 0.006) in the multivariate Cox model. CONCLUSIONS: There was only 59% correlation between the surgical assessment and post operative CT findings of residual disease in patients reported to have undergone optimal surgery. Stage and residual disease as assessed by the surgeon were significant prognostic factors for overall survival. The value for postoperative CT may lie in those cases with small-volume residual disease (visible but reported as G1 cm) at surgery.
Assuntos
Neoplasia Residual/diagnóstico , Neoplasias Ovarianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico por imagem , Neoplasia Residual/cirurgia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Prognóstico , Estudos Retrospectivos , Análise de SobrevidaRESUMO
BACKGROUND: There is evidence to suggest a link between the accumulation of visceral abdominal adipose tissue and an increased incidence of prostate, endometrial, breast, and colonic cancer. PURPOSE: To investigate whether an increase in ratio of visceral to subcutaneous abdominal adipose tissue is demonstrated in patients with testicular teratoma. MATERIAL AND METHODS: Following ethical approval, 22 male patients who had undergone staging computed tomography (CT) between 2004 and 2007 for testicular teratoma were identified from our database. Abdominal adipose tissue distribution for these 22 patients was compared with that of 22 control patients, standardized for age, sex, and body mass index. Visceral and subcutaneous adipose tissue volumes were calculated from a single axial CT slice at the level of the umbilicus. A two-sample t test for the difference in volume ratio between the two groups was used. A P value of < 0.05 was considered statistically significant. RESULTS: There was a statistically significant difference in the mean ratio of visceral to subcutaneous volumes between the teratoma patients and controls (P=0.02). The ratio in teratoma patients was 1.56 times greater than seen in control patients. CONCLUSION: Patients with testicular teratoma have a relatively greater proportion of abdominal visceral adipose tissue compared with controls. This is concordant with published literature for other malignancies.
Assuntos
Gordura Intra-Abdominal/patologia , Obesidade Abdominal/epidemiologia , Teratoma/etiologia , Neoplasias Testiculares/etiologia , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/complicações , Obesidade Abdominal/diagnóstico por imagem , Prevalência , Fatores de Risco , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: Repeated computed tomography (CT) assessment of the adrenal glands is associated with a significant radiation burden. The increasing capabilities of magnetic resonance (MR) volumetric analysis of the adrenals make this a potentially alternative technique in man. PURPOSE: To determine whether MR imaging could be used to measure adrenal volume, and to determine the intra- and interobserver variation and repeatability of MR volume imaging of adrenals in healthy human subjects. MATERIAL AND METHODS: This was a single-cohort, sequential design, three-part study involving four MRI examinations per subject following ethical approval and informed consent. Information was collected on four healthy subjects (three male and one female). Two different investigators estimated the area of the adrenal gland for each of the 3-mm contiguous slices (and consequently adrenal volume). In order to estimate inter- and intrareader variability, a repeated-measures mixed model was fitted with adrenal volume as the dependent variable. In order to estimate any bias between readers, Bland-Altman methodology was applied. RESULTS: Intraobserver variation for adrenal gland volume is approximately 5% of a 3-cm(3 )adrenal gland. Interobserver variation is approximately 9% of a 3-cm(3) adrenal gland. Potential variation in measurement for adrenal volume from all sources equates to approximately 14% of a 3-cm(3) adrenal gland. Verification of image reading by a second investigator (consensus reading) reduces variability. CONCLUSION: Analysis of adrenal gland volume using MRI is a potentially reliable technique that could be used to assess a pathological change in adrenal size.
Assuntos
Glândulas Suprarrenais/anatomia & histologia , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Projetos Piloto , Estudos ProspectivosRESUMO
The differential diagnosis for adnexal masses is wide, encompassing a range of benign, borderline, and malignant entities. Stratification of risk is made on age, menopausal status, imaging features, and tumor markers. This review outlines the different imaging modalities available to characterize adnexal masses, describes the typical ultrasound and magnetic resonance imaging features of the most commonly encountered adnexal lesions, and provides a suggested imaging algorithm in the management of such patients.
Assuntos
Doenças dos Anexos/diagnóstico , Imageamento por Ressonância Magnética/métodos , Ultrassonografia de Intervenção/métodos , Neoplasias Uterinas/diagnóstico , Anexos Uterinos/diagnóstico por imagem , Anexos Uterinos/patologia , Diagnóstico Diferencial , Feminino , HumanosRESUMO
Magnetic resonance imaging (MRI) has become an established imaging modality for characterizing pelvic pathology, chiefly because of superb contrast resolution and lack of ionizing radiation. In recent years, MRI has been used to stage vulval and vaginal malignancies and assist detection of recurrence. It has also proved useful in the characterization of Müllerian duct anomalies. We review the typical imaging characteristics on MRI of congenital and acquired conditions involving the vulva and vagina.
Assuntos
Imageamento por Ressonância Magnética/métodos , Doenças Vaginais/diagnóstico , Doenças da Vulva/diagnóstico , Feminino , Humanos , Ductos Paramesonéfricos/patologia , Vagina/patologia , Doenças Vaginais/congênito , Vulva/patologia , Doenças da Vulva/congênitoRESUMO
In patients with suspected advanced ovarian carcinoma, a precise histological diagnosis is required before commencing neo-adjuvant chemotherapy. This study aims to determine the diagnostic accuracy and complication rate of percutaneous biopsies performed under ultrasound or computed tomography guidance. Between 2002 to 2007, 60 consecutive image-guided percutaneous biopsies were performed in patients with suspected ovarian cancer. The following variables were recorded: tissue biopsied, imaging technique, experience of operator, biopsy needle gauge, number of passes, complications, and final histology. Forty-seven patients had omental biopsies, 12 pelvic mass biopsies, and 1 para-aortic lymph node biopsy. Thirty-five biopsies were performed under ultrasound, 25 under computed tomography guidance. Biopsy needle gauges ranged from 14-20 swg with two to five passes for each patient. There were no complications. Histology was obtained in 52 (87%) patients. Percutaneous image-guided biopsy of peritoneal disease or pelvic mass is safe with high diagnostic accuracy. The large-gauge biopsy needle is as safe as the small gauge needle, but has the added value of obtaining tissue samples for immunohistochemistry and genomic studies.
Assuntos
Biópsia por Agulha/métodos , Neoplasias Ovarianas/patologia , Radiografia Intervencionista/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia Intervencionista/efeitos adversos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Recent developments in chemotherapy have resulted in several new drug treatments for metastatic renal cell carcinoma (RCC). These therapies have shown improved progression-free survival and are applicable to many more patients than the conventional cytokine-based treatments for metastatic RCC. Consequently imaging is playing a greater part in the management of such patients. Computed tomography (CT) remains the primary imaging modality with other imaging modalities playing a supplementary role. CT is used in the diagnosis and staging of metastatic RCC. It is used in the follow-up of patients after nephrectomy, in assessing the extent of metastatic disease, and in evaluating response to treatment. This review looks at the role of CT in patients with metastatic RCC and describes the appearances of metastatic RCC before and following systemic therapy.
Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pélvicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Neoplasias Abdominais/secundário , Neoplasias Ósseas/secundário , Neoplasias Encefálicas/secundário , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/patologia , Meios de Contraste , Humanos , Rim/diagnóstico por imagem , Rim/efeitos dos fármacos , Rim/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pélvicas/secundário , Intensificação de Imagem Radiográfica/métodosRESUMO
INTRODUCTION: Small renal masses (SRMs; ≤4 cm) account for two-thirds of new diagnoses of kidney cancer, the majority of which are incidental findings. The natural history of the SRM seems largely indolent. There is an increasing concern regarding surgical overtreatment and the associated health burden in terms of morbidity and economy. Observational data support the safety and efficacy of percutaneous cryoablation but there is an unmet need for high-quality evidence on non-surgical management options and a head-to-head comparison with standard of care is lacking. Historical interventional trial recruitment difficulties demand novel study conduct approaches. We aim to assess if a novel trial design, the cohort embedded randomised controlled trial (RCT), will enable carrying out such a comparison. METHODS AND ANALYSIS: Single-centre prospective cohort study of adults diagnosed with SRM (n=200) with an open label embedded interventional RCT comparing nephron sparing interventions. Cohort participants will be managed at patient and clinicians' discretion and agree with longitudinal clinical data and biological sample collection, with invitation for trial interventions and participation in comparator control groups. Cohort participants with biopsy-proven renal cell carcinoma eligible for both percutaneous cryoablation and partial nephrectomy will be randomly selected (1:1) and invited to consider percutaneous cryoablation (n=25). The comparator group will be robotic partial nephrectomy (n=25). The primary outcome of this feasibility study is participant recruitment. Qualitative research techniques will assess barriers and recruitment improvement opportunities. Secondary outcomes are participant trial retention, health-related quality of life, treatment complications, blood transfusion rate, intensive care unit admission and renal replacement requirement rates, length of hospital stay, time to return to pre-treatment activities, number of work days lost, and health technologies costs. ETHICS AND DISSEMINATION: Ethical approval has been granted (UK HRA REC 19/EM/0004). Study outputs will be presented and published. TRIAL REGISTRATION: ISRCTN18156881; Pre-results.
Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/métodos , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Tratamentos com Preservação do Órgão/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Carcinoma de Células Renais/patologia , Estudos de Viabilidade , Humanos , Neoplasias Renais/patologia , Néfrons , Estudos Prospectivos , Carga TumoralAssuntos
COVID-19 , Neoplasias Renais , Neoplasias da Bexiga Urinária , Urologia , Humanos , SARS-CoV-2RESUMO
Accurate preoperative reporting is essential in guiding the surgeon in deciding when and how to operate safely and effectively. Critically, this relies on an understanding of the operative issues faced by the surgeon, which is not always appreciated by the radiologist. This paper therefore aims to address this, first focusing on relevant anatomical variants, and then issues specific to laparoscopic cholecystectomy, hepatic transplantation, and finally hepatic resection (including cholangiocarcinoma resection). Throughout the paper, there is an emphasis on associated surgical techniques to add context to the discussion.
Assuntos
Ductos Biliares/anatomia & histologia , Ductos Biliares/cirurgia , Hepatopatias/diagnóstico , Fígado/anatomia & histologia , Fígado/cirurgia , Cuidados Pré-Operatórios/métodos , Colangiopancreatografia por Ressonância Magnética/métodos , Colecistectomia Laparoscópica/métodos , Humanos , Fígado/irrigação sanguínea , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
The complexity of hepatobiliary procedures continues to evolve at a rapid rate, with an increasing number of living donor liver transplants and extensive cancer resections being performed. The associated complications are a significant cause of morbidity and mortality, and are often complex injuries, involving both vascular and biliary structures. In this paper we describe the complications associated with laparoscopic cholecystectomy, liver transplant surgery, and hepatic resection. Focus is on the classical imaging appearances, imaging modality options, and varying management strategies for these injuries, to show how the radiologist's role is vital in ensuring the correct diagnosis is made and the appropriate treatment is instigated.
Assuntos
Ductos Biliares/cirurgia , Diagnóstico por Imagem/métodos , Fígado/cirurgia , Complicações Pós-Operatórias/diagnóstico , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Humanos , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Complicações Pós-Operatórias/etiologiaRESUMO
Magnetic resonance cholangiopancreatography is a method of evaluating the pancreaticobiliary tree through the use of heavily T2-weighted magnetic resonance images. Despite being introduced approximately 2 decades ago, it remains the best noninvasive diagnostic tool for this purpose, facilitated by advances in imaging acquisition and technique. The purpose of this review is to describe the protocol at our institution, highlight the pitfalls the reader needs to be aware of when interpreting magnetic resonance cholangiopancreatography images, and demonstrate the different pathologies that it can be used to investigate.
Assuntos
Doenças dos Ductos Biliares/diagnóstico , Ductos Biliares/patologia , Colangiopancreatografia por Ressonância Magnética/métodos , Pancreatopatias/diagnóstico , Ductos Pancreáticos/patologia , Artefatos , Humanos , Guias de Prática Clínica como AssuntoRESUMO
Hepatocyte-specific contrast agents have been made available in the last 15 years for magnetic resonance imaging of the liver. These agents are differentially taken up by functioning hepatocytes and excreted in the biliary system. They can help distinguish focal liver lesions of hepatocellular origin from lesions of nonhepatocellular origin, and can also be used in the evaluation of the biliary tree. The purpose of this review is to summarize the different types of hepatocyte-specific contrast agents presently available, their use in the characterization of focal liver lesions, their role in the evaluation of biliary pathology, and their potential future applications.
Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Meios de Contraste , Aumento da Imagem/métodos , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Ductos Biliares/patologia , Ácido Edético/análogos & derivados , Gadolínio DTPA , Hepatócitos , Humanos , Fígado/patologia , Meglumina/análogos & derivados , Compostos Organometálicos , Fosfato de Piridoxal/análogos & derivadosRESUMO
Magnetic resonance cholangiopancreatography (MRCP) is a technique that has evolved over the past two decades. It continues to have a fundamental role in the non-invasive investigation of many pancreatico-biliary disorders. The purpose of this review is to summarise the key concepts behind MRCP, the different techniques that are currently employed (including functional and secretin-stimulated MRCP), the pitfalls the reader should be aware of, and the main clinical indications for its use.
RESUMO
Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn's disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition. Main Messages ⢠MR enterography (MRE) is the preferred imaging investigation to assess Crohn's disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used. ⢠MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging. ⢠MRE can help define disease activity, a key question in the management of Crohn's disease. ⢠MRE can help distinguish between inflammatory, stricturing and penetrating disease. ⢠MRE can demonstrate both mural and extramural complications.