1,721,087 research outputs found
Reverse Mirizzi Syndrome
Full text linkA man in his 40s presented to our Hospital with abdominal pain, jaundice, and pruritus. He had a history of Alagille Syndrome treated with cholecystojejunostomy in the neonatal period because of initial misdiagnosis of biliary atresia. Laboratory investigations showed hyperbilirubinemia (total bilirubin 1.76 mg/dL [<1.2 mg/dL]; conjugated 1.06 mg/dL [<0.3 mg/dL]) and cholestasis (GGT 78 U/L [<50 U/L]; ALP 200 U/L [<50 U/L]). Transabdominal ultrasound was limited by aerobilia due to the cholecystojejuno-anastomosis. Subsequent basal CT scan revealed an impacted stone within the patient's native common bile duct (CBD). Aerobilia in intrahepatic bile ducts and gallbladder was reported. Magnetic Resonance cholangiopancreatography confirmed the gallstone in the CBD compressing cystic duct and common hepatic duct, with dilation of the upstream bile ducts. Furthermore, the native CBD was obstructed by other gallstones. In Mirizzi syndrome, gallstones impacted in gallbladder's Hartmann's pouch or cystic duct extrinsically compress CBD. We suggest naming the present condition “Reverse Mirizzi Syndrome” (Renzulli Matteo Syndrome, RMS) because it is the exact opposite of Mirizzi syndrome
Focal lesions in the cirrhotic liver: Their pivotal role in gadoxetic acid-enhanced MRI and recognition by the Western guidelines
No full textHepatocellular carcinoma (HCC) is a major health concern, and early HCC diagnosis is a primary radiological concern. The goal of imaging liver cirrhosis is the early identification of high-grade dysplastic nodules/early HCC since their treatment is associated with a higher chance of radical cure and lower recurrence rates. The newly introduced MRI contrast agent gadoxetic acid (gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, Gd-EOB-DTPA) has enabled the concurrent assessment of tumor vascularity and hepatocyte-specific contrast enhancement during the hepatobiliary phase (HBP), which can help to detect and characterize smaller HCCs and their precursors. HBP-EOB-MRI identifies hypovascular HCC nodules that are difficult to detect using ultrasonography or computed tomography, which do not show the diagnostic HCC hallmarks of arterial washin and portal/delayed washout. During the HBP, typical HCC and early HCC appear hypointense on EOB-MRI, whereas lowgrade dysplastic or regenerative nodules appear as iso- or hyperintense lesions. The diagnostic accuracy of EOB-MRI for the diagnosis of early HCC is approximately 95-100%. One third of hypovascular hypointense nodules in HBP become hypervascular 'progressed' HCC, with a 1- and 3-year cumulative incidence of 25 and 41%, respectively. Therefore, these hypovascular nodules should be strictly followed up or definitely treated as typical HCC. Due to this capability of identifying the precursors and biological behavior of HCC, EOB-MRI has rapidly become a key imaging tool for the diagnosis of HCC and its precursors, despite the scarce MRI availability throughout Europe. With increasing experience, EOB-MRI may eventually be established as the diagnostic imaging modality of choice in this setting. Full recognition by the Western EASL-AASLD guidelines is expected
Proposal of a new diagnostic algorithm for hepatocellular carcinoma based on the Japanese guidelines but adapted to the Western world for patients under surveillance for chronic liver disease
No full textTo date, despite many scientific evidences, the guidelines of the principal hepatological societies, such as the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver, do not recognize the diagnostic superiority of magnetic resonance imaging (MRI) over computed tomography in the diagnosis of hepatocellular carcinoma (HCC) and, for the most part, do not contemplate the use of hepatospecific contrast media, such as gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB). The aim of this paper was to analyze the recent results of EOB-MRI in the study of chronic liver disease and the differences between the American Association for the Study of Liver Diseases and the Japan Society of Hepatology guidelines, of which the latter represents the most consolidated experience on EOB-MRI use for HCC diagnosis. Finally, a new diagnostic algorithm for HCC in patients under surveillance for chronic liver disease was formulated, which contemplates the use of EOB. This new diagnostic algorithm is based on the Japan Society of Hepatology algorithm but goes beyond it by adapting it to the Western world, taking into account both the difference between the two and the latest results concerning the diagnosis of HCC. This new diagnostic algorithm for HCC is proposed in order to provide useful diagnostic tools to all those Western countries where the use of EOB (more expensive than extracellular contrast media) is widespread but in which common strategies to manage the nodules that this new contrast agent allows identifying have not been available to date
Biliary Variant in a Potential Liver Donor
No full textA55 year-oldmanwith no known medical conditions or surgical history presented to our hospital to be evaluated as potential living liver donor. In our centre donor candidates are evaluated using a specific living donor protocol; this includes imaging studies for liver volumetrics (to quantify the amount of parenchyma that could
be donated versus the remnant) and liver vascular anatomy, and magnetic resonance cholangiopancreatography (MRCP) to evaluate anatomy of the biliary tree. Computed tomography scanning was performed to estimate volume of the right and left lobes of the liver: the right lobe would be harvested for transplantation into the recipient, while the left would be the donor’s remnant liver; the test confirmed adequate volume of both liver lobes.
MRCP showed biliary variants characterized by a right posterior hepatic duct (RPHD), which in classic biliary anatomy fuses with the right anterior duct to constitute a short right hepatic duct, draining directly into the common hepatic duct (CHD) (Fig. 1A, arrow). MRCP also showed that the cystic duct, which usually drains into
the lateral aspect of the CHD below its origin, drained directly into theRPHDabove its confluence with theCHD(Fig. 1B, arrow). Classic biliary anatomy appears in about 58% of the population, while the variant in which RPHD drains directly into the CHD has a prevalence of approximately 5% [1]. These anatomical biliary variants are relevant in potential donors evaluated for living donor liver transplantation
MAGNETIC RESONANCE (MRI) AND COMPUTED TOMOGRAPHY (CT) FOR CHOLANGIOCARCINOMA
No full textHigh quality cross-sectional Multidetector Computed Tomography and/or Magnetic Resonance Imaging play an important role in diagnosis, localization, and staging and planning of the optimal management of cholangiocarcinoma. Correct imaging helps to localize the tumor to either the intrahepatic, the perihilar or the distal bile ducts, each of which requires different management. It accurately stages the disease, identifying the presence of significant nodal and distant metastasis or major vascular encasement of the portal vein or the hepatic arteries, or depicts extensive involvement of the hepatic duct reaching up to second-order biliary radicals. It also helps to identify the extent of local tumor invasion, which has a major impact on management.
This chapter presents the spectrum of appearances of cholangiocarcinomas at cross-sectional imaging and examines the possibilities of imaging modalities in the proper stage classification of bile duct tumors according to the recent staging systems
MANUALE DI DIAGNOSTICA PER IMMAGINI PER IL CORSO DI LAUREA IN MEDICINA E CHIRURGIA. DIAGNOSTICA PER IMMAGINI DEL FEGATO, DELLA MILZA, DEL PERITONEO E MESENTERE. 2°edizione CAPITOLO 8 - 10 - 13
No full text1) DIAGNOSTICA PER IMMAGINI DEL FEGATO di R. Golfieri, M. Renzulli, A. Cappelli (Capitolo 8 pag.157-218): Nello studio della patologia epatica hanno un ruolo essenziale l'ecografia (US) completata da eco-color Doppler (ECD) e da mdc (ecocontrastografia), la TC, la RM e la colangio-RM. La scintigrafia e l'angiografia hanno un ruolo in settori ben definiti. 2) DIAGNOSTICA PER IMMAGINI DELLA MILZA di R. Golfieri, A. Cappelli (Capitolo 10 pag. 245-270): II compito principale delle metodiche di imaging è quello di: determinare il volume splenico, individuare eventuali lesioni focali, fornire una definizione nosografia delle splenomegalie, associate o meno a ipersplenismo e riconoscere la rottura della milza secondo i gradi di gravità 3) DIAGNOSTICA PER IMMAGINI DEL PERITONEO E MESENTERE di R. Golfieri, V. Orsini, B. Corcioni (Capitolo 13 pag. 319-2342
PERCUTANEOUS TREATMENT OF BILIARY AND VASCULAR COMPLICATIONS
No full textAdvances in surgical techniques and immunosuppression have made liver transplantation (LT) a first-line treatment for many patients with end-stage liver disease. The early imaging detection and the technological improvements in miniinvasive treatment of postoperative complications have contributed significantly to improved graft and patient survival, with interventional radiology playing a pivotal role in the multidisciplinary team following LT recipients
The Influence of Gd-EOB-DTPA on T2 Signal Behavior: An Example from Clinical Routine
Full text linkIn the literature, it has repeatedly been stated that the introduction of hepatospecific contrast agents in Magnetic Resonance Imaging prolongs the acquisition time due to the hepatobiliary phase, normally acquired 15–20 min after injection. Many efforts have been made to shorten the time-consuming protocols, and it was demonstrated that T2-Weighted Images (T2WI) and Diffusion-Weighted Images (DWI) acquired after Gd-EOB-DTPA show a comparable diagnostic capability to pre-contrast T2WI and DWI in the detection and characterization of hepatic tumors. Therefore, T2WI and DWI are usually acquired after the acquisition of vascular phases, in the dead time until the acquisition of the hepatobiliary phase. Unfortunately, contrast agents, especially Gd-EOB-DTPA, reduce the hydrogen nuclei’s relaxation time and modify signal intensity. We report a case in which, due to these limitations of the acquisition protocol, two hemangiomas showed an inhomogeneous, low signal on T2WI and DWI that was not visible in a follow-up scan a few days later. In conclusion, when liver lesions of unknown nature must be characterized, and there is a lack of previous radiological investigations, it could be useful to acquire pre-contrast T2WI and DWI to avoid diagnostic confusion, especially in non-tertiary centers
Calculation of conversion factors for effective dose for various interventional radiology procedures
No full textPurpose: To provide dose-area-product (DAP) to effective dose (E) conversion factors for complete interventional procedures, based on in-the-field clinical measurements of DAP values and using tabulated E/DAP conversion factors for single projections available from the literature. Methods: Nine types of interventional procedures were performed on 84 patients with two angiographic systems. Different calibration curves (with and without patient table attenuation) were calculated for each DAP meter. Clinical and dosimetric parameters were recorded in-the-field for each projection and for all patients, and a conversion factor linking DAP and effective doses was derived for each complete procedure making use of published, Monte Carlo calculated conversion factors for single static projections. Results: Fluoroscopy time and DAP values for the lowest-dose procedure (biliary drainage) were approximately 3-fold and 13-fold lower, respectively, than those for the highest-dose examination (transjugular intrahepatic portosystemic shunt, TIPS). Median E/DAP conversion factors from 0.12 (abdominal percutaneous transluminal angioplasty) to 0.25 (Nephrostomy) mSvGy-1 cm-2 were obtained and good correlations between E and DAP were found for all procedures, with R2 coefficients ranging from 0.80 (abdominal angiography) to 0.99 (biliary stent insertion, Nephrostomy and TIPS). The DAP values obtained in this study showed general consistency with the values provided in the literature and median E values ranged from 4.0 mSv (biliary drainage) to 49.6 mSv (TIPS). Conclusions: Values of E/DAP conversion factors were derived for each procedure from a comprehensive analysis of projection and dosimetric data: they could provide a good evaluation for the stochastic effects. These results can be obtained by means of a close cooperation between different interventional professionals involved in patient care and dose optimization. © 2012 American Association of Physicists in Medicine
Radiologic criteria of response to systemic treatments for hepatocellular carcinoma
No full textSorafenib has been the only approved systemic therapy for hepatocellular carcinoma until very recently. However, the radiologic assessment of its biological activity is a disputed matter as at least five different criteria have been proposed. In this review, we describe the characteristic of the Response Evaluation Criteria In Solid Tumors (RECIST), European Association for the Study of The Liver (EASL), modified RECIST (mRECIST), Response Evaluation Criteria In the Cancer of the Liver (RECICL) and Choi criteria. The existing comparative studies are reported together with recent pieces of evidence, analyzing the reasons behind the split between recommendations of the scientific societies and regulatory agencies. Future perspectives in the wake of the impending results of the immunotherapy trials are also discussed
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