RESUMEN
OBJECTIVES: In adults, elevated hepatic venous pressure gradients (HVPGs) are correlated with the degree of liver fibrosis on histopathology and predict worse outcomes including variceal bleeding and death. We aimed to examine the association between HVPG measurements, histopathologic findings, and clinical indicators of portal hypertension in children. METHODS: Utilizing retrospective data from 2 pediatric centers between 2006 and 2015, we identified children who underwent simultaneous HVPG measurement and transjugular liver biopsy. Medical charts were reviewed for histopathology, imaging, endoscopic, and clinical data. RESULTS: Forty-one children (median age 11 years) were included in the analysis with diagnoses of acute hepatitis (nâ=â15), chronic liver disease (nâ=â12), hepatic noncirrhotic portal hypertension (nâ=â4), acute liver failure (nâ=â3), and nonhepatic causes of portal hypertension (nâ=â7). Elevated mean HVPG measurements were found in children with acute liver failure (10 mmHg, range 4-12) and chronic liver disease (7 mmHg, range 1-12). HVPG measurements did not correlate with the histological severity of fibrosis (ρâ=â0.23, Pâ=â0.14) or portal inflammation (ρâ=â0.24, Pâ=â0.29), and no difference was found in HVPG when comparing children with and without a history of variceal bleeding (Pâ=â0.43). CONCLUSIONS: HVPG measurements do not correlate significantly with the degree of hepatic fibrosis on biopsy. Furthermore, HVPG measurements are not associated with the presence of varices or history of variceal bleeding, suggesting the possibility of intrahepatic shunting in children with advanced liver disease. Therefore, unlike in adults, HVPG measurements may not accurately predict children who are at risk of complications from portal hypertension.
Asunto(s)
Hipertensión Portal/diagnóstico , Pruebas de Función Hepática/estadística & datos numéricos , Presión Portal , Índice de Severidad de la Enfermedad , Biopsia , Niño , Femenino , Humanos , Hipertensión Portal/fisiopatología , Hígado/irrigación sanguínea , Hígado/diagnóstico por imagen , Hígado/fisiopatología , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/fisiopatología , Pruebas de Función Hepática/métodos , Masculino , Vena Porta/diagnóstico por imagen , Vena Porta/fisiopatología , Portografía/estadística & datos numéricos , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
RATIONALE AND OBJECTIVES: The Liver Imaging Reporting and Data System (LI-RADS) is a newly developed nomogram for standardizing the performance and interpretation of liver imaging. However, it is unclear which imaging technique is optimal to exactly define LI-RADS scale. This study aims to determine the concordance of computed tomography (CT) and magnetic resonance imaging (MRI) for the classification of hepatic nodules (HNs) using a LI-RADS scoring system. MATERIALS AND METHODS: Major imaging features (arterial hyper-enhancement, washout, pseudo-capsule, diameter, and tumor embolus) on CT versus MRI for 118 HNs in 84 patients with diffuse liver disease were rated independently using LI-RADS by two groups of readers. Inter-reader agreement (IRA) and intraclass agreement was determined by Fleiss and Cohen's kappa (κ). Logistic regression for correlated data was used to compare diagnostic ability. RESULTS: IRA was perfect for determination of nodule size and tumor embolus (κ = 0.94-0.98). IRA was moderate to substantial for determination of arterial hyper-enhancement, washout, and pseudo-capsule (κ = 0.54-0.72). Intraclass agreement between CT and MRI was substantial for determination of washout (0.632 [95% CI: 0.494, 0.771]) and pseudo-capsule (0.670 [95% CI: 0.494, 0.847]), and fair for arterial hyper-enhancement (0.203 [95% CI: 0.051, 0.354]). CT against MR produced false-negative findings of arterial hyper-enhancement by 57.1%, washout by 21.2%, and pseudo-capsule by 42.9%; and underestimated LI-RADS score by 16.9% for LR 3, 37.3% for LR 4, and 8.5% for LR 5. CT produced significantly lower accuracy (54.3% vs 67.8%, P < 0.001) and sensitivity (31.6% vs 71.1%, P < 0.001) than MRI in the prediction of malignancy. CONCLUSIONS: There are substantial discordance between CT and MR for stratification of HNs using LI-RADS. MRI could be better than CT in optimizing the performance of LI-RADS.
Asunto(s)
Neoplasias Hepáticas/diagnóstico , Imagen por Resonancia Magnética/estadística & datos numéricos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Adulto , Anciano , Arterias/patología , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/diagnóstico por imagen , Reacciones Falso Negativas , Femenino , Humanos , Aumento de la Imagen , Interpretación de Imagen Asistida por Computador/normas , Hígado/irrigación sanguínea , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Células Neoplásicas Circulantes/patología , Nomogramas , Vena Porta/patología , Portografía/estadística & datos numéricos , Intensificación de Imagen Radiográfica , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
RATIONALE AND OBJECTIVES: The aim of this article was to study the influence of different adaptive statistical iterative reconstruction (ASIR) percentages on the image quality of dual-energy computed tomography (DECT) portal venography in portal hypertension patients. MATERIALS AND METHODS: DECT scans of 40 patients with cirrhosis (mean age, 56 years) at the portal venous phase were retrospectively analyzed. Monochromatic images at 60 and 70 keV were reconstructed with four ASIR percentages: 0%, 30%, 50%, and 70%. Computed tomography (CT) numbers of the portal veins (PVs), liver parenchyma, and subcutaneous fat tissue in the abdomen were measured. The standard deviation from the region of interest of the liver parenchyma was interpreted as the objective image noise (IN). The contrast-noise ratio (CNR) between PV and liver parenchyma was calculated. The diagnostic acceptability (DA) and sharpness of PV margins were obtained using a 5-point score. The IN, CNR, DA, and sharpness of PV were compared among the eight groups with different keV + ASIR level combinations. RESULTS: The IN, CNR, DA, and sharpness of PV of different keV + ASIR groups were all statistically different (P < 0.05). In the eight groups, the best and worst CNR were obtained in the 60 keV + 70% ASIR and 70 keV + 0% ASIR (filtered back-projection [FBP]) combination, respectively, whereas the largest and smallest objective IN were obtained in the 60 keV + 0% ASIR (FBP) and 70 keV + 70% combination. The highest DA and sharpness values of PV were obtained at 50% ASIR for 60 keV. CONCLUSIONS: An optimal ASIR percentage (50%) combined with an appropriate monochromatic energy level (60 keV) provides the highest DA in portal venography imaging, whereas for the higher monochromatic energy (70 keV) images, 30% ASIR provides the highest image quality, with less IN than 60 keV with 50% ASIR.
Asunto(s)
Hipertensión Portal/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/estadística & datos numéricos , Tomografía Computarizada Multidetector/estadística & datos numéricos , Portografía/estadística & datos numéricos , Imagen Radiográfica por Emisión de Doble Fotón/estadística & datos numéricos , Grasa Abdominal/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Artefactos , Femenino , Hepatitis B/diagnóstico por imagen , Hepatitis C/diagnóstico por imagen , Humanos , Hígado/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática Alcohólica/diagnóstico por imagen , Cirrosis Hepática Biliar/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía Abdominal/estadística & datos numéricos , Estudios Retrospectivos , Relación Señal-Ruido , Grasa Subcutánea/diagnóstico por imagenRESUMEN
Helical computed tomography with arterioportography (CTAP) and intraoperative sonography (IOUS) are both recognized to be extremely sensitive in the detection of liver metastases measuring <2 cm in diameter. As sensitivity and specificity values for both techniques differ significantly in the literature and in default of sufficient published data regarding this subject, a lesion-by-lesion analysis was considered necessary. Accuracy of IOUS was compared with helical computed tomography (CT) and portal-phase contrast enhancement (CTAP) in the preoperative detection of liver metastases from colorectal carcinoma projected as a prospective blinded study. Cost efficiency should be determined. Liver CTAP and IOUS were evaluated in 33 patients with colorectal carcinoma. Metastases were resected in 10 cases, and the remaining 23 patients were observed for follow-up with CT investigations every 3 months for a period of 1 year. CTAP and IOUS detected all 13 lesions measuring 5-10 mm (13/13). One metastasis measuring >10 mm was missed by IOUS. CTAP presented an ideal sensitivity of 100%, but specificity was as low as 68%. IOUS sensitivity was 98% and specificity was 95%. IOUS and CTAP are of comparable value regarding the detection of liver metastases <10 mm. Both techniques may be used if resections of synchronous or metachronous metastases are planned in order not to miss limiting small lesions and to prevent superfluous liver surgery. Helical CT scan with dynamic intravenous contrast enhancement is considered the most cost-effective preoperative staging method, although local staging may not be achieved because of insufficient intraabdominal survey.
Asunto(s)
Neoplasias Colorrectales/patología , Cuidados Intraoperatorios/métodos , Neoplasias Hepáticas/secundario , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Anciano de 80 o más Años , Angiografía/métodos , Angiografía/estadística & datos numéricos , Femenino , Hepatectomía , Humanos , Cuidados Intraoperatorios/estadística & datos numéricos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Portografía/métodos , Portografía/estadística & datos numéricos , Estudios Prospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Ultrasonografía Intervencional/instrumentación , Ultrasonografía Intervencional/estadística & datos numéricosRESUMEN
PURPOSE: To evaluate the accuracy of spiral computed tomography during arterial portography (SCTAP) in the detection, localization, and resectability of liver tumors in a correlative study between radiology and intraoperative findings. METHOD AND MATERIALS: Retrospectively, SCTAP images of 168 consecutive patients before liver tumor resection were analyzed. The SCTAP studies (100 ml lopromid 300 by automated injector with a flow of 3 ml/s; slice thickness, table feed and reconstruction index 5 mm each; scan-delay 30 s; 120 kV; 250 mAs) were evaluated for the detection, localization, and resectability of focal liver lesions by three experienced radiologists in consensus and were correlated with histopathological and intraoperative findings where available (59/168). RESULTS: The sensitivity of SCTAP for the detection of liver tumors was 91% for all lesions and 84% for lesions < 1 cm. The specificity was only 19% due to a high rate of false-positive lesions (30%) and preselection effects. Typical pitfalls in false positive lesions were inhomogeneous liver perfusion near the portal vein, the falciform ligament, and the gallbladder (19/42). In 30% of the patients SCTAP correctly diagnosed inoperability, in 23% the intraoperative tumor expansion was larger than expected from SCTAP images, which would have changed operability. CONCLUSION: The SCTAP has a high sensitivity in the detection and localization of liver tumors and is a valuable method in the preoperative diagnostic procedure. The method is limited by many false-positive lesions often due to inhomogeneous liver perfusion and the insufficient evaluation of local tumor spread. Therefore, SCTAP should be replaced by MRI in the near future.
Asunto(s)
Medios de Contraste , Hepatectomía , Yohexol/análogos & derivados , Hígado/diagnóstico por imagen , Portografía/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Femenino , Humanos , Cuidados Intraoperatorios , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Portografía/estadística & datos numéricos , Pronóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/estadística & datos numéricos , UltrasonografíaRESUMEN
PURPOSE: Pseudolesions are sometimes seen around the falciform ligament, around the gallbladder, or at the posterior edge of the medical segment on CT during arterial portography. The purpose of this study was to investigate the influence of liver cirrhosis on these pseudolesions. METHOD: The basis of this study was 33 patients with liver cirrhosis or hepatitis (group A) and 43 with neither (group B). The standard for diagnosis was surgical findings. We investigated whether there was a difference in the frequency of each pseudolesion between groups A and B. When tumors were seen in each location, they were excluded from statistical analysis. RESULTS: Pseudolesion around the falciform ligament was seen in none of 32 patients in group A and in 18 of 40 in group B (4 cases were excluded), around the gallbladder in 14 of 30 in group A and 16 of 42 in group B (4 cases were excluded), and at the posterior edge of the medial segment in 13 of 33 in group A and 16 of 42 in group B (1 case was excluded). There was a statistically significant difference in the frequency of pseudolesion around the falciform ligament (p < 0.001, Fisher test), but not around the gallbladder or posterior edge of the medial segment. CONCLUSION: Liver cirrhosis decreases the frequency of pseudolesions around the falciform ligament, but not around the gallbladder or posterior edge of the medial segment.
Asunto(s)
Cirrosis Hepática/diagnóstico por imagen , Hígado/diagnóstico por imagen , Portografía , Tomografía Computarizada por Rayos X , Adulto , Anciano , Distribución de Chi-Cuadrado , Enfermedad Crónica , Medios de Contraste , Diagnóstico Diferencial , Femenino , Hepatitis/diagnóstico por imagen , Humanos , Ligamentos/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Portografía/métodos , Portografía/estadística & datos numéricos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricosRESUMEN
PURPOSE: To determine if a relationship exists between the right portal trunk (RPT) and bony structures that might aid guidance of needle passes into the RPT during transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: Sixty-two TIPS portal venograms were reviewed. The distance of the mid-RPT from the lateral margin of the vertebral column was measured and calculated as a fraction of the adjacent vertebral body width. The cephalocaudal height of the RPT was compared with that of the posterior ribs and rib spaces. The cephalocaudal height was evaluated with frequency distribution, and scattergram plots were used to determine the most common location of the mid-RPT relative to bony structures. The height and lateral position were analyzed in relation to clinical parameters to determine the effect of these parameters on RPT position. RESULTS: The mean distance of the mid-RPT from the lateral vertebral margin was 0.9 vertebral widths (range, 0.1-1.5). Fifty-six of 62 (90%) mid-RPTs were between 0.5 and 1.5 vertebral widths to the right of the lateral margin of the vertebrae. Fifty-four of 62 (87%) mid-RPTs were below the 10th and above the 12th ribs. Clinical factors did not affect RPT position. CONCLUSION: Bony landmarks provide an approximation of the mid-RPT location and may aid in TIPS placement.
Asunto(s)
Vena Porta/anatomía & histología , Costillas/anatomía & histología , Vértebras Torácicas/anatomía & histología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Venas Yugulares , Masculino , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Derivación Portosistémica Quirúrgica , Portografía/estadística & datos numéricos , Estudios Retrospectivos , Costillas/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagenRESUMEN
To evaluate the accuracy of CT arterial portography (CTAP) of the liver, CTAP examinations from 111 patients were retrospectively reviewed and compared with the findings at laparotomy. Laparotomy had been performed within 3 weeks after the CTAP examination. In cases of resectable liver tumor, the result from the pathologic examination report was used to calculate the accuracy of CTAP. In cases of nonresectable liver tumor or liver without tumor, CTAP findings were compared with the result of a thorough inspection and palpation of the liver. The right liver lobe and the medial and lateral segments of the left lobe were separately evaluated. Thus, a total of 333 lobes/segments were evaluated. Tumor was found at laparotomy in 80 of 333 lobes or segments. At CTAP a total of 94 lobes were evaluated as positive for tumor growth, 23 of these were falsely interpreted as positive and 9 were falsely interpreted as negative when compared with the findings at laparotomy. However, 3 patients called false-positives later turned out to be true-positives since the lesions were overlooked at operation. A sensitivity of 89%, a specificity of 91%, and an accuracy of 90% was calculated for CTAP. It is concluded that CTAP has a higher accuracy than other radiologic methods and should be considered suitable for preoperative evaluation of potentially resectable liver tumor.
Asunto(s)
Arteria Hepática/diagnóstico por imagen , Hígado/patología , Portografía/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Estudios de Evaluación como Asunto , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Laparotomía , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Portografía/instrumentación , Portografía/estadística & datos numéricos , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/estadística & datos numéricosRESUMEN
En una serie de 38 pancreatitis crónicas se observaron 13 pacientes con hipertensión portal segmentaria manifestada por esplenomegalia y várices esofágicas efectuándosele esplenomanometrías y esplenoportografías por punción esplénica. En 11 casos se comprobó una trombosis del tronco de la vena esplénica, en 1 paciente una cavernomatosis esplenoportal total y en uno se halló patología. Sólo un paciente sufrió hemorragias digestivas por ruptura varicosa. Esta repercusión venosa esplénica se relacionó con lesiones histopatológicas graves que obligaron a una intervención quirúrgica en 10 de los 12 pacientes.
Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Masculino , Femenino , Enfermedad Crónica , Hipertensión Portal/diagnóstico , Hipertensión Portal/etiología , Pancreatitis/diagnóstico , Manometría/estadística & datos numéricos , Pancreatitis/complicaciones , Pancreatitis/cirugía , Portografía/estadística & datos numéricos , Estudios Retrospectivos , Esplenomegalia/diagnóstico , Várices Esofágicas y Gástricas/epidemiología , Várices Esofágicas y Gástricas/etiologíaRESUMEN
En una serie de 38 pancreatitis crónicas se observaron 13 pacientes con hipertensión portal segmentaria manifestada por esplenomegalia y várices esofágicas efectuándosele esplenomanometrías y esplenoportografías por punción esplénica. En 11 casos se comprobó una trombosis del tronco de la vena esplénica, en 1 paciente una cavernomatosis esplenoportal total y en uno se halló patología. Sólo un paciente sufrió hemorragias digestivas por ruptura varicosa. Esta repercusión venosa esplénica se relacionó con lesiones histopatológicas graves que obligaron a una intervención quirúrgica en 10 de los 12 pacientes. (AU)