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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Radiologists perform differential diagnoses of hepatic (liver) masses using ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and laboratory tests, but interpretation is often difficult. In our earlier research, a backpropagation neural network was designed to diagnose five classifications of hepatic masses: metastatic carcinoma, hepatoma, cavernous hemangioma, abscess, and cirrhosis. After being trained using ultrasonographic data and laboratory tests, the network classified hepatic masses correctly in 51 of 72 cases. That accuracy of 71% is higher than the 50% scored by the average radiology resident in training but lower than the 90% scored by the typical board-certified radiologist. What do we need to do to increase that accuracy and make the network friendly enough that radiologists will use it in their diagnoses? We have reviewed the literature, discussed alternatives and developed a plan to improve the diagnostic accuracy of the networks. That plan consists of: (i) get many more patient cases and more data variables, including MRI and CT data, so the network can be more highly trained. A shortage of enough patient cases to properly train the network is the key problem; (ii) use genetic algorithms and other techniques to preprocess the data; (iii) the network should have an optical interface to read images directly; and (iv) build a user-friendly interface using the C programming language on a 486 microcomputer. Continued research along the guidelines in this study should provide a sophisticated neural network for early detection of hepatic cancer that hopefully will exceed the diagnostic abilities of most radiologists.
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PMID:How to improve a neural network for early detection of hepatic cancer. 816 71

In 47 patients with liver cirrhosis, we performed dynamic MRI with a multisection FLASH technique that enabled us to obtain 13 T 1-weighted images of the entire liver within a single breath hold. Computed tomographic arterial portography (CTAP), US, CT, angiography (AOG) and MRI (spin echo [SE] and dynamic MRI) were performed in all 47 patients. Except for cyst, hemangioma and metastatic tumor, 104 focal nodules less than 3 cm in diameter were detected. These 104 focal lesions were divided into three groups according to the pattern of CTAP: 69 portal supply negative, 11 portal supply decreased, and 24 portal supply normal. In the portal supply negative group, 63 lesions (91%) were detected by dynamic MRI, which was superior to other modalities (US 77%, CT 41%, AOG 70%, MRI-SE 61%). The superiority of dynamic MRI resulted from its excellent ability to detect liver lesions less than 1 cm in diameter. We confirmed histologically that dynamic MRI had almost the same ability to detect hepatocellular carcinoma (HCC) as CTAP. Dynamic MRI should be clinically useful as a noninvasive examination for the detection of HCC.
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PMID:[Evaluation of multislice dynamic MR imaging of the whole liver]. 819 Jun 5

To evaluate the diagnostic accuracy of fine-needle aspiration, fine-needle biopsy and extranodular fine needle biopsy in identifying focal lesions in cirrhosis, 100 consecutive ultrasound detected nodules were studied. Seventy-three were hepatocellular carcinomas (31 were well-differentiated hepatocellular carcinomas), 23 were benign lesions (one angioma and 22 large regenerative nodules) and two were metastases. The lesions were divided according to maximum diameter as follows: < 20 mm in 36, > 20 < 30 mm in 27, and > 30 mm in 33. In four cases there were multiple nodules of different sizes. Fine needle aspiration, intranodular fine needle biopsy and extranodular fine needle biopsy were obtained in each lesion. The sensitivity, specificity and diagnostic accuracy of each procedure were evaluated separately by three independent pathologists. Seven fine needle aspirations and three intranodular fine needle biopsies were considered inadequate. The highest diagnostic accuracy (96%) was obtained by the combined analysis of fine needle aspiration plus intranodular and extranodular fine needle biopsy, and this superiority was confirmed in each group of lesions. Fine needle aspiration showed a lower accuracy (48%) than intranodular fine needle biopsy (67%). When fine needle aspiration and intranodular fine needle biopsy were evaluated together, an accuracy of 91% was found. Intralesional fine needle biopsy plus extranodular fine needle biopsy analysis gave an accuracy of 78% and, particularly relevant, a specificity of 95%. These results indicate that, in patients with cirrhosis with nodular lesions < 30 mm, fine needle biopsy is superior to fine needle aspiration and that the combined evaluation of fine needle aspiration plus intranodular and extranodular fine needle biopsy is the most accurate approach.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis. 820 Dec 12

A T1-weighted inversion-recovery (IR) sequence was used to study 15 patients with possible fatty change in the liver. The inversion time (TI) was calculated for optimal suppression of normal liver signal (t-null). Conventional spin-echo (SE) and short TI IR (STIR) sequences were also performed. For seven documented benign focal fatty liver lesions, the T1-weighted IR (fat-enhanced) sequence clearly enabled differentiation of normal from fat-infiltrated liver, whereas three of these lesions were isointense to normal liver with all other sequences. The livers of the other nine patients (two normal, one with diffuse fatty change, two with metastatic disease, one with hemangioma, one with focal nodular hyperplasia, one with simple cyst, and one with micronodular cirrhosis) showed homogeneous reduction of liver signal with the fat-enhanced IR sequence.
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PMID:Characterization of focal fatty change in the liver with a fat-enhanced inversion-recovery sequence. 834 50

Technical aspects (equipment, presetting, enhancement) are considered together with new approaches like interventional radiology and Doppler ultrasound. In liver tumors Doppler US not always shows typical patterns: in hemangioma there is usually poor vascularization, while in malignant tumors the data are: high speed arterial blood flow; turbulent flow in the feeding artery; changes in arterial flow pattern; decreased or reversed flow in the portal branch; arterio-portal or arterio-venous shunts; neovascularization in the tumor; compression, displacement and infiltration of blood vessels. Quantitative measurements by Doppler US in portal hypertension indicate that the cross-sectional area is enlarged and the portal blood flow velocity is decreased. Collateral blood flow usually indicates a turbulent flow. A classification of portal hypertension can be done using Doppler-US, according to the existing site of elevated vascular resistance: pre-sinusoidal, sinusoidal and post-sinusoidal. The first type is represented by extra-hepatic portal vein obstruction. Typical case of second type is cirrhosis of the liver caused by alcoholic or viral hepatitis. Budd-Chiari syndrome is a typical case of the third type.
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PMID:Doppler ultrasound in diagnosis of liver tumor and portal hypertension. 839 42

The main goal of our study was to test dynamic CT capability to characterize focal liver lesions. We examined 57 patients: 6 were affected with focal nodular hyperplasia (FNH), 19 with hepatocellular carcinoma (HCC), 1 with a regenerating nodule on cirrhosis; 14 patients had metastases, 3 focal fatty infiltration, 1 a necrotic nodule, 1 a non-Hodgkin's lymphoma, 1 a cysto-adeno-cholangiocarcinoma and 11 hemangiomas. All lesions were identified with US and the diagnosis was confirmed with the gold standard technique--that is, biopsy or surgery, and red blood cell SPECT for hemangiomas. All lesions were studied with a CT multiphase protocol consisting of a single-level dynamic phase followed by an incremental dynamic phase and finally by a delayed phase to study prolonged and delayed enhancement. Single-level dynamic bolus CT requires an injection of 60 ml nonionic contrast agent administered with a power injector into a cubital vein, at a rate of 5 ml/s. Scanning begins 10 seconds after the injection and consists of 6 series of 2 scans each; each scan lasts 2 seconds and is obtained during the same respiratory apnea, with a 5-second interscan pause. In this phase, 12 scans 5 mm thick are obtained, lasting 24 seconds in all, with pauses lasting 25 seconds--in all, 49 seconds. The next phase is the dynamic incremental scanning, to study the whole liver: this phase requires a 50-ml contrast agent injection at a rate of 4 ml/s, followed by 70 ml at a rate of 1 ml/sec, using 5 mm slice thickness and 8 mm scan interval. This results in 16 scans, beginning 20 seconds after the injection, with a scan time of 2 seconds and 4 seconds of interscan delay, 92 seconds in all. In the last phase, scanning begins 5 minutes after the injection, with a maximum delay of 10-15 minutes. Enhancement variations in both the lesions and the surroundings parenchyma, as related to time, were collected together with morphological data. Time density curves were grouped according to histologic classification and red blood cells SPECT findings; the curves were analyzed with the regression analysis. The results were obtained by analyzing a series of equations describing the different densities of the lesion and the surrounding parenchyma at fixed time intervals, integrated with morphological data, and then comparing the groups of lesions with each other. The regression analysis of the density curves and of the morphological data allowed us to correctly differentiate the 4 most frequent types of lesions--that is, hemangioma, HCC, FNH and metastasis--in 89% of the patients.
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PMID:[Dynamic computed tomography in the characterization of focal hepatic lesions]. 861 39

The transmission of donor-related malignancies by organ transplantation is a rather rare event. There has only been one report on the development of a brain tumor metastasis in liver transplantation. From September 1988 to January 1993, 342 donor hepatectomies with subsequent transplantation were performed at our center. The main donor diagnoses included subarachnoidal bleeding (n = 128; 37.4%), isolated head injury (n = 114; 33.3%), multiple injuries (n = 55; 16.1%), primary cerebral neoplasia (n = 13; 3.8%), and other (n = 32; 9.4%). Primary cerebral neoplasia included glioblastoma (n = 4), meningioma (n = 3), astrocytoma (n = 2), angioma (n = 2), neurocytoma (n = 1), and ependymoma (n = 1). In the group of donors suffering from primary cerebral neoplasia, procured organs other than the liver included kidneys (n = 20), combined kidneys and pancreata (n = 1), pancreata (n = 2), hearts (n = 8), combined hearts and lungs (n = 1), and single lungs (n = 1). Follow-up of the respective graft recipients ranged from 28 to 68 months (median 43 months). Recurrent malignancy was observed once, in a liver graft recipient. The donor, a 48-year-old female, had undergone surgical resection of an intracerebral multiform glioblastoma and died 4 months later of a relapse in the brain stem. The 28-year-old female recipient had undergone transplantation for an autoimmune-hepatitic cirrhosis. Four months later, histopathological examination of an intraperitoneal and intrahepatic mass revealed a poorly differentiated, small-cell pleomorphic cancer, identified as a glioma metastasis by S100- and glial fibrillary acidic protein immunohistochemical staining. The patient died 6 months post-transplantation. On autopsy, no further neoplastic lesions were detected. Our review adds a second reported case of a liver graft-transmitted brain tumor to the literature and the fourth donor-related malignancy after hepatic transplantation in general.
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PMID:Liver graft-transmitted glioblastoma multiforme. A case report and experience with 13 multiorgan donors suffering from primary cerebral neoplasia. 900 60

The treatment outcomes were analysed in 37 patients with intrahepatic arterioportal fistulas (IAPF) of various etiology. In 21 patients with fistulas in the presence of hepatoma, surgical resection (n = 4), hepatic arterial embolization with a hemostatic sponge and metallic spirals (n = 7) and conservative therapy (n = 10) were used. In 4 large iatrogenic IAPF, embolization was conducted just after making a diagnosis; in other 7 cases, a follow-up was accompanied by control arteriography. Embolization was done in all 5 patients with large spontaneous IAPF in the intact and cirrhosis- or hemangioma-related liver. One fatal outcome was observed after embolization in the presence of severe hepatic failure. No other complications were registered. Symptoms of elevated pressures in the portal vein regressed in most patients. It is concluded that despite the cause of occurrence, long-term IAPF results in hyperkinetic portal hypertension, followed by bleeding from the esophageal and gastric varicosity. Arterial embolization of IAPF in the hepatoma reduces the risk for fatal hemorrhage. Small iatrogenic IAPF should be followed up by making control arteriography. Arterial occlusion is the treatment of choice for spontaneous and persistent iatrogenic IAPF. Severe chronic hepatic failure is a contraindication for embolization.
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PMID:[Role of transcatheter embolization in intrahepatic arterioportal fistulas]. 902 73

Advances in operative, diagnostic and post-operative care technique have rendered liver resections safe. Consecutively, indications for operative interventions in primary and secondary liver tumors have changed. A current state of the art is presented. Focal nodular hyperplasia, if found incidentally during laparotomy, should be removed en-passant. Large or central lesions should be biopsied and can be observed if they remain asymptomatic and stable in size. Symptomatic or growing FNH should be removed. If the diagnosis is evasive resection should be favored. Most patients with hepatocellular adenoma are symptomatic and the lesion should therefore be removed. Hemangiomas are rarely causing symptoms. In case they truly are, or if they cause complications they should be excised. Anatomical resections for hepatocellular carcinoma are only feasible in non-cirrhotic livers or in patients with cirrhosis and compensated liver function. Other patients are candidates for liver transplantation if the cancer is stage I or II. Stage III and IVa lesions are subject of current studies. Surgical resection remains the only potentially curative treatment for intrahepatic cholangiocellular carcinoma. Because of their dismal prognosis these patients are not candidates for transplantation. Resection continues to be the most effective therapy for colorectal metastases to the liver. Patients with non-colorectal, non-neuroendocrine metastases are usually only candidates for surgical palliation. Cure can be achieved in patients with renal cell carcinoma or Wilms' tumor. Additionally, neuroendocrine metastases to the liver can be resected in curative intent if extrahepatic disease was excluded. In the few symptomatic patients in whom extrahepatic disease was excluded, symptomatic treatment has failed, and the lesions are not resectable, liver transplantation can provide a reasonable therapeutic choice.
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PMID:[Surgical therapy of primary and secondary liver tumors]. 906 25

The incidence and characteristics of hepatic tumors -primitive or secondary- were analyzed in a series of 596 patients with cirrhosis and on whom an autopsy was carried out. A hepatic tumor was discovered in 43.6%: 96.5% with histological findings of malignant disease and only 3.4% with benign disease. The tumors discovered showed the following in order of frequency: hepatocellular carcinoma (90.3%), hepatic metastases (4.2%), cholangiocarcinoma (2.3%), adenoma (1.5%), hemangioma (1.2%) and hamartoma (0.8%). Therefore, 10% of the neoplasms located in the cirrhotic liver were different from the hepatocellular carcinoma. In 2% of the subjects with hepatic tumors, two histologically different lesions were found to co-exist in the liver, and in every case it was found to be a hepatocellular carcinoma related to another tumor, which further complicated the diagnosis. The most frequent type of hepatocellular carcinoma was multinodular, although diffuse tumors most frequently developed metastases. When the hepatocellular carcinoma was uninodular and small, distal spread was exceptional. Metastatic infiltration of the liver by neoplasms of different origin, characteristically infrequent in cirrhosis, was always accompanied by spread to other organs and did not appear as a single nodule in any case. We conclude that the correct diagnosis of tumor-related lesions located, in a cirrhotic liver is occasionally difficult during life, especially when the neoplasms are different from the hepatocellular carcinoma.
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PMID:Hepatic tumors in patients with cirrhosis: an autopsy study. 940 34


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