Nonalcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome and may evolve into hepatocellular carcinoma (HCC). Only scanty clinical information is available ...on HCC in NAFLD. The aim of this multicenter observational prospective study was to assess the clinical features of patients with NAFLD‐related HCC (NAFLD‐HCC) and to compare them to those of hepatitis C virus (HCV)‐related HCC. A total of 756 patients with either NAFLD (145) or HCV‐related chronic liver disease (611) were enrolled in secondary care Italian centers. Survival was modeled according to clinical parameters, lead‐time bias, and propensity analysis. Compared to HCV, HCC in NAFLD patients had a larger volume, showed more often an infiltrative pattern, and was detected outside specific surveillance. Cirrhosis was present in only about 50% of NAFLD‐HCC patients, in contrast to the near totality of HCV‐HCC. Regardless of tumor stage, survival was significantly shorter (P = 0.017) in patients with NAFLD‐HCC, 25.5 months (95% confidence interval 21.9‐29.1), than in those with HCV‐HCC, 33.7 months (95% confidence interval 31.9‐35.4). To eliminate possible confounders, a propensity score analysis was performed, which showed no more significant difference between the two groups. Additionally, analysis of patients within Milan criteria submitted to curative treatments did not show any difference in survival between NAFLD‐HCC and HCV‐HCC (respectively, 38.6 versus 41.0 months, P = nonsignificant) Conclusions: NAFLD‐HCC is more often detected at a later tumor stage and could arise also in the absence of cirrhosis, but after patient matching, it has a similar survival rate compared to HCV infection; a future challenge will be to identify patients with NAFLD who require more stringent surveillance in order to offer the most timely and effective treatment. (Hepatology 2016;63:827–838)
The prognosis of untreated patients with hepatocellular carcinoma (HCC) is heterogeneous, and survival data were mainly obtained from control arms of randomized studies. Clinical practice data on ...this topic are urgently needed, so as to help plan studies and counsel patients. We assessed the prognosis of 600 untreated patients with HCC managed by the Italian Liver Cancer Group. Prognosis was evaluated by subdividing patients according to the Barcelona Clinic Liver Cancer (BCLC) classification. We also assessed the main demographic, clinical, and oncological determinants of survival in the subgroup of patients with advanced HCC (BCLC C). Advanced (BCLC C: n = 138; 23.0%) and end‐stage HCC (BCLC D; n = 210; 35.0%) represented the majority of patients. Overall median survival was 9 months, and the principal cause of death was tumor progression (n = 279; 46.5%). Patients' median survival progressively and significantly decreased as BCLC stage worsened (BCLC 0: 38 months; BCLC A: 25 months; BCLC B: 10 months; BCLC C: 7 months; BCLC D: 6 months; P < 0.0001). Female gender (hazard ratio HR = 0.55; 95% confidence interval CI = 0.33‐0.90; P = 0.018), ascites (HR = 1.81; 95% CI = 1.21‐2.71; P = 0.004), and multinodular (>3) HCC (HR = 1.79; 95% CI = 1.21‐2.63; P = 0.003) were independent predictors of survival in patients with advanced HCC (BCLC C). Conclusion: BCLC adequately predicts the prognosis of untreated HCC patients. In untreated patients with advanced HCC, female gender, clinical decompensation of cirrhosis, and multinodular tumor are independent prognostic predictors and should be taken into account for patient stratification in future therapeutic studies. (Hepatology 2015;61:184–190)
Objectives
To evaluate a semi-automated segmentation and ventilated lung quantification on chest computed tomography (CT) to assess lung involvement in patients affected by SARS-CoV-2. Results were ...compared with clinical and functional parameters and outcomes.
Methods
All images underwent quantitative analyses with a dedicated workstation using a semi-automatic lung segmentation software to compute ventilated lung volume (VLV), Ground-glass opacity (GGO) volume (GGO-V), and consolidation volume (CONS-V) as absolute volume and as a percentage of total lung volume (TLV). The ratio between CONS-V, GGO-V, and VLV (CONS-V/VLV and GGO-V/VLV, respectively), TLV (CONS-V/TLV, GGO-V/TLV, and GGO-V + CONS-V/TLV respectively), and the ratio between VLV and TLV (VLV/TLV) were calculated.
Results
A total of 108 patients were enrolled. GGO-V/TLV significantly correlated with WBC (
r
= 0.369), neutrophils (
r
= 0.446), platelets (
r
= 0.182), CRP (
r
= 0.190), PaCO
2
(
r
= 0.176), HCO
3
−
(
r
= 0.284), and PaO2/FiO2
(P
/
F
) values (
r
= − 0.344). CONS-V/TLV significantly correlated with WBC (
r
= 0.294), neutrophils (
r
= 0.300), lymphocytes (
r
= −0.225), CRP (
r
= 0.306), PaCO
2
(
r
= 0.227), pH (r = 0.162), HCO
3
−
(
r
= 0.394), and
P
/
F
(
r
= − 0.419) values. Statistically significant differences between CONS-V, GGO-V, GGO-V/TLV, CONS-V/TLV, GGO-V/VLV, CONS-V/VLV, GGO-V + CONS-V/TLV, VLV/TLV, CT score, and invasive ventilation by ET were found (all
p
< 0.05).
Conclusion
The use of quantitative semi-automated algorithm for lung CT elaboration effectively correlates the severity of SARS-CoV-2-related pneumonia with laboratory parameters and the need for invasive ventilation.
Key Points
• Pathological lung volumes, expressed both as GGO-V and as CONS-V, can be considered a useful tool in SARS-CoV-2-related pneumonia.
• All lung volumes, expressed themselves and as ratio with TLV and VLV, correlate with laboratory data, in particular C-reactive protein and white blood cell count.
• All lung volumes correlate with patient’s outcome, in particular concerning invasive ventilation.
To evaluate the imaging features of routine admission chest X-ray in patients referred for novel Coronavirus 2019 infection.
All patients referred to the emergency departments, RT-PCR positive for ...SARS-CoV-2 infection were evaluated. Demographic and clinical data were recorded. Two radiologists (8 and 15 years of experience) reviewed all the X-ray images and evaluated the following findings: interstitial opacities, alveolar opacities (AO), AO associated with consolidation, consolidation and/or pleural effusion. We stratified patients in groups according to the time interval between symptoms onset (cut-off 5 days) and X-ray imaging and according to age (cut-off 60 years old). Computed tomography was performed in case of a discrepancy between clinical symptoms, laboratory and X-ray findings, and/or suspicion of complications.
A total of 468 patients were tested positive for SARS-CoV-2. Lung lesions primarily manifested as interstitial opacities (71.7%) and AO opacities (60.5%), more frequently bilateral (64.5%) and with a peripheral predominance (62.5%). Patients admitted to the emergency radiology department after 5 days from symptoms onset, more frequently had interstitial and AO opacities, in comparison to those admitted within 5 days, and lung lesions were more frequently bilateral and peripheral. Older patients more frequently presented interstitial and AO opacities in comparison to younger ones. Sixty-eight patients underwent CT that principally showed the presence of ground-glass opacities and consolidations.
The most common X-ray pattern is multifocal and peripheral, associated with interstitial and alveolar opacities. Chest X-ray, compared to CT, can be considered a reliable diagnostic tool, especially in the Emergency setting.
•SARS-CoV-2 pulmonary findings are typically bilateral and subpleural.•Symptoms onset time of 5 days is a reliable cut-off.•Pulmonary findings are age-related.
Background & Aims Lead-time is the time by which diagnosis is anticipated by screening/surveillance with respect to the symptomatic detection of a disease. Any screening program, including ...surveillance for hepatocellular carcinoma (HCC), is subject to lead-time bias. Data regarding lead-time for HCC are lacking. Aims of the present study were to calculate lead-time and to assess its impact on the benefit obtainable from the surveillance of cirrhotic patients. Methods One-thousand three-hundred and eighty Child–Pugh class A/B patients from the ITA.LI.CA database, in whom HCC was detected during semiannual surveillance (n = 850), annual surveillance (n = 234) or when patients came when symptomatic (n = 296), were selected. Lead-time was estimated by means of appropriate formulas and Monte Carlo simulation, including 1000 patients for each arm. Results The 5-year overall survival after HCC diagnosis was 32.7% in semiannually surveilled patients, 25.2% in annually surveilled patients, and 12.2% in symptomatic patients ( p <0.001). In a 10-year follow-up perspective, the median lead-time calculated for all surveilled patients was 6.5 months (7.2 for semiannual and 4.1 for annual surveillance). Lead-time bias accounted for most of the surveillance benefit until the third year of follow-up after HCC diagnosis. However, even after lead-time adjustment, semiannual surveillance maintained a survival benefit over symptomatic diagnosis (number of patients needed to screen = 13), as did annual surveillance (18 patients). Conclusions Lead-time bias is the main determinant of the short-term benefit provided by surveillance for HCC, but this benefit becomes factual in a long-term perspective, confirming the clinical utility of an anticipated diagnosis of HCC.
Background: The aim of the present study is to determine the feasibility of biopsy for atypical liver nodules in patients under surveillance for hepatocellular carcinoma (HCC), assessing which ...factors influence the decision to perform it. Methods: A total of 128 atypical liver nodules in 108 patients under surveillance for HCC, who underwent CT between September 2018 and September 2019, were included. All the images were saved digitally (on CD-ROM) and the two most representative images in the arterial and delayed phases were selected for each lesion and inserted into a digital atlas (on PDF). Two experienced radiologists (Readers 1 and 2) reviewed both the CD-ROM and the PDF to define the feasibility of biopsy in both scenarios, specifying the reasons for the unfeasibility of biopsy. The intra-observer variability and inter-observer variability were assessed. Results: When reviewing the PDF, 76 (59.4%) and 68 (53.1%) nodules were deemed unfeasible for biopsy by the less experienced radiologist (Reader 1) and the more experienced radiologist (Reader 2), respectively (p = 0.604). When reviewing the entire CT study, both percentages decreased slightly (Reader 1 = 70/128 (54.7%); Reader 2 = 61/128 (47.6%); p = 0.591). The intra-reader agreement on the PDF was substantial (k = 0.648 (95% CI = 0.513–0.783)). The inter-reader agreement on the PDF was slight (k = 0.185 (95% CI = 0.021–0.348)) and moderate on the entire CT study (k = 0.424 (95% CI = 0.269–0.579)). When assessing the PDF, the nodule size (10–20 mm) and location in segments six and eight were negatively and positively associated with the feasibility of liver biopsy, respectively. When assessing the CD-ROM, only the nodule dimension was associated with the unfeasibility of liver biopsy. Conclusions: The unfeasibility of liver biopsy is mainly due to the small size of the lesions and their location.
In 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.
Liver iron overload is defined as an accumulation of the chemical element Fe in the hepatic parenchyma that exceeds the normal storage. When iron accumulates, it can be toxic for the liver by ...producing inflammation and cell damage. This can potentially lead to cirrhosis and hepatocellular carcinoma, as well as to other liver lesions depending on the underlying condition associated to liver iron overload. The correct assessment of liver iron storage is pivotal to drive the best treatment and prevent complication. Nowadays, magnetic resonance imaging (MRI) is the best non-invasive modality to detect and quantify liver iron overload. However, due to its superparamagnetic properties, iron provides a natural source of contrast enhancement that can make challenging the differential diagnosis between different focal liver lesions (FLLs). To date, a fully comprehensive description of MRI features of liver lesions commonly found in iron-overloaded liver is lacking in the literature. Through an extensive review of the published literature, we aim to summarize the MRI signal intensity and enhancement pattern of the most common FLLs that can occur in liver iron overload.
Objectives
To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging in the detection of prostate cancer, according to Prostate Imaging Reporting and Data System, and the ...usefulness of combining clinical parameters to improve patients’ risk assessment.
Methods
Overall, 201 patients underwent multiparametric magnetic resonance imaging investigation with a 3‐T magnet and a 32‐channel body coil based on triplanar high‐resolution T2‐weighted, diffusion‐weighted and T1‐weighted dynamic contrast‐enhanced imaging before, during and after intravenous administration of paramagnetic contrast agent. Random transrectal ultrasound‐guided biopsy was carried out for all eligible patients. If a Prostate Imaging Reporting and Data System ≥3 lesion was present, a targeted biopsy with magnetic resonance imaging‐transrectal ultrasound fusion‐guided system was carried out.
Results
Sensitivity, specificity, positive predictive value and negative predictive value of Prostate Imaging Reporting and Data System ≥3 lesions for the detection of prostate cancer were 65.1%, 54.9%, 43.1% and 75.0% respectively, with an accuracy of 64.2% (55.1–72.7%). At uni‐ and multivariate analysis, age ≥70 years and prostate‐specific antigen density ≥0.15 ng/mL/mL were significantly associated with prostate cancer. A new risk model named “modified Prostate Imaging Reporting and Data System” was created considering age and prostate‐specific antigen density in addition to the Prostate Imaging Reporting and Data System score showing an improved correlation with prostate cancer compared with the Prostate Imaging Reporting and Data System alone (area under curve 71.4%, 95% confidence interval 62.2–80.5 vs area under curve 62.6%, 95% confidence interval 52.1–73; P ≤ 0.0001).
Conclusions
The accuracy of Prostate Imaging Reporting and Data System alone in the diagnosis of prostate cancer might be suboptimal, whereas a novel risk model based on the combination of multiparametric magnetic resonance imaging data with clinical parameters could offer higher discrimination and improve the ability of diagnosing clinically significant disease.
Reverse Mirizzi Syndrome Franceschi, Paola; Brandi, Nicolò; Pecorelli, Anna ...
Radiology case reports,
11/2023, Letnik:
18, Številka:
11
Journal Article
Recenzirano
Odprti dostop
A 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.
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