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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article reviews the diagnosis of liver metastases by sonography and computed tomography. The ultrasonographic and computer tomographic features of hepatic metastases are described emphasizing the various signs of malignancy and the differential diagnosis of focal liver disease. The advantages and disadvantages of each imaging technique as well as a diagnostic approach in the evaluation of hepatic tumors are discussed.
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PMID:[Sonographic and computed tomographic diagnosis of liver metastases. A review]. 298 7

In evaluating nuclear magnetic tomography for the diagnosis of liver disease, one must differentiate between circumscribed and diffuse lesions. Nuclear magnetic tomography provides additional information for lesions which are echogenic on ultrasound and can differentiate between metastases, haemangiomas and hamartomas. In diffuse parenchymal disease measurement of relaxation time can differentiate between fatty liver, cirrhosis (alcoholic, primary biliary), haemochromatosis (cirrhotic transformation) and hepatoma. NMR spectroscopy is a method for the future.
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PMID:[Differential diagnosis of liver diseases in the nuclear spin tomogram]. 298 31

We examined 21 patients with focal lesions of the liver. Routinely we used T1 weighted, proton weighted and T2 weighted measurement modes, mainly with repetition times of 1.6 sec and echo delay times of 35 or 120 msec. Using these parameters we can see characteristic changes of the signals of the liver tumours. Cystic lesions usually show a strong decrease of the signal in the T1 weighted images in comparison with the normal liver pattern, in the proton weighted images a weak decrease but also in some cases a weak increase of the signal; in the T2 weighted images they show signals of very great intensity. We can differentiate haemangioma of cystic lesions because of the very strong signal in the proton weighted images in comparison with the normal liver pattern, which we could not see in any other focal liver disease. Metastases and hepatoma produced low signal intensity in the T1 weighted image. The proton weighted and the T2 weighted images show signals with a slightly greater intensity compared with the normal pattern, i.e. a very good possibility to distinguish hepatoma and metastases from cystic lesions or haemangioma. The differentiation from hepatoma and metastases cannot be made with NMR up to now. We are also not able to differentiate the focal nodular hyperplasia (FNH) from metastases. We used a 0.35 T supraconductive magnetic system.
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PMID:[Initial experiences with MR in liver tumors]. 299 37

Fifty-four patients underwent total hepatectomy and liver replacement in the presence of a primary liver malignancy. In 13 recipients in whom the hepatic tumors were incidental to some other endstage liver disease, recurrence was not seen and 12 of the 13 patients are alive after 4 months to 15 1/2 years. In contrast, tumors recurred in 3 of every 4 patients who received liver replacement primarily because of hepatic malignancies that could not be resected by conventional techniques of subtotal hepatectomy and who lived for at least 2 months after transplantation. The most encouraging results were in patients with the fibrolamellar hepatocellular carcinomas that grow slowly and metastasize late, but even with this lesion, the recurrence rate was 57%. In future trials, additional effective anticancer therapy will be needed to improve the results of liver transplantation for primary liver malignancy, but what an improved strategy should be has not yet been defined.
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PMID:Role of liver transplantation in cancer therapy. 299 49

Serum biomarkers are not very reliable in assessing outcome or predicting recurrence of breast cancer. Clinically, carcinoembryonic antigen (CEA) is widely used and is elevated in a majority of patients with metastatic breast cancer. However, it is falsely elevated in a wide range of nonmalignant conditions and correlates poorly with disease progression. We evaluated a newly described monoclonal antibody, CA 549, in an immunoradiometric assay which uses two monoclonal antibodies directed against tumor and milk fat globule membranes. CA 549 and CEA were studied in 682 patients, 331 of whom had breast diseases and 99 of whom were followed with multiple serum samples. Of 69 patients with benign breast diseases, 1.5% had elevated CA 549, 0% of 30 pregnant women had elevated CA 549, and 26% of patients with nonmalignant liver disease had CA 549 elevation. In metastatic cancer of prostate, ovary, endometrium, colon, and lung CA 549 was elevated in 12% to 50% of cases with levels less than 120 U/mL. In breast cancer, CA 549 was elevated in 11% of 88 patients who received adjuvant chemotherapy and had no evidence of metastasis; in 23% of 16 patients in complete remission after chemotherapy; in 63% of 52 patients in partial remission after therapy; and in 83% of 106 patients with progression of breast cancer compared with 63% with elevated CEA (P = .001). In diseases of the breast, CA 549 has a sensitivity In diseases of the breast, CA 549 has a sensitivity and specificity of 77% and 92% v 61% and 92% for CEA. Of 99 patients serially monitored with clinically documented breast cancer progression, regression, or stability of disease, CA 549 was statistically significantly superior to CEA in monitoring a greater than 25% change in those patients with metastatic progression (P = .03). CA 549 is a new serum marker that should be control tested in prospective clinical trials alone or in conjunction with other markers.
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PMID:A new biomarker in monitoring breast cancer: CA 549. 305 75

Over a 24-year period, 411 partial hepatic resections were performed: 142 right or left trisegmentectomies, 158 lobectomies, 25 segmentectomies, and 86 local excisions. The operations were performed for benign lesions in 182 patients, for primary hepatic malignancies in 106, and for hepatic metastases in 123, including 90 from colorectal cancers. The 30-day (operative) mortality rate was 3.2%, and there were an additional six late deaths (1.5%) due to hepatic failure caused by the resection. The highest operative mortality rate (6.3%) resulted from the trisegmentectomies, but this merely reflected the extent of the disease being treated. A mortality rate of 8.5% for patients with primary hepatic malignancy was associated not only with the extensiveness of lesions, but also with cirrhosis in the remaining liver fragment. There was no mortality for 123 patients with metastatic disease, 100 patients with cavernous hemangioma, 22 with liver cell adenoma, 17 with focal nodular hyperplasia, 16 with congenital cystic disease, and five with hydatid cysts. Trauma, pre-existing iatrogenic injury, and cirrhosis were the only conditions that had lethal portent in patients with benign disease. Furthermore, patients with benign disease who survived operation had minimal liability from recurrence of their original disease and none from the resection per se. By contrast, tumor recurrence dominated the actuarial survival rates for cancer patients, which at 1 and 5 years were 68.5% and 31.9%, respectively, after resection for primary hepatic malignancy, and 84.2% and 29.5%, respectively, for hepatic metastases. In this report, the expanding role of partial hepatectomy in the treatment of liver disease was emphasized, as well as the need for considering, in some cases, the alternative of total hepatectomy and liver replacement.
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PMID:Personal experience with 411 hepatic resections. 317 30

Data were collected over a six-month period from in-hospital cardiopulmonary resuscitation (CPR) patients (aged 18 years and older) who were admitted to a public hospital. The sample population was mostly male (55.4 percent), primarily black (90.6 percent), with a mean age of 61 years. Medical expenses for these patients were largely covered by public funds or medical charities, reflecting the predominately low socioeconomic status of the population. The proportion of patients discharged alive after in-hospital CPR was 6.1 percent. The CPR sample contains a large proportion of patients in the terminal phase of diseases such as metastatic cancer, acquired immune deficiency syndrome (AIDS), and end-stage liver disease. Chart reviews revealed that do-not-resuscitate (DNR) orders were not presented as a therapeutic option to either patient or family in the majority of instances. These findings indicate a need to develop standards and strategies for decision making about the use of CPR specific to this population.
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PMID:The need for a do-not-resuscitate policy in a public city hospital. 324 12

Four-dimensional chemical shift imaging was used to map spatial variations in phosphorus metabolites in a patient with carcinoid metastases in the liver. The results were compared to those from an age and sex matched volunteer, with no known previous history of liver disease. In the patient local abnormalities were observed. These included elevated phosphomonoester and decreased phosphodiester concentrations relative to adenosine triphosphate. The regions of abnormality corresponded to regions containing metastases identified with x-ray computed tomography and magnetic resonance imaging.
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PMID:Four-dimensional phosphorus-31 chemical shift imaging of carcinoid metastases in the liver. 327 24

To determine the accuracy of magnetic resonance (MR) imaging relative to computed tomography (CT) in the diagnosis of liver metastases, a randomized, controlled study was conducted of 135 subjects, including 57 with cancer metastatic to the liver, 27 with benign cysts or hemangiomas, and 51 without focal liver disease. The sensitivity of MR imaging for detecting individual metastatic deposits was 64%, significantly greater than 51% for CT (P less than .001); the difference in sensitivity for identifying patients with one or more hepatic metastases was less (82% for MR imaging vs. 80% for CT). In patients without hepatic metastases, the specificity of MR imaging was 99% versus 94% for CT. Significant differences were found between individual MR pulse sequences in detection of individual lesions. The sensitivity of both T1-weighted spin-echo (SE) (64%) and inversion-recovery (IR) (65%) pulse sequences was significantly (P less than .001) greater than either the TE (echo time) 60 msec (43%) or TE 120 msec (43%) T2-weighted pulse sequences. Overall, the accuracy of a single T1-weighted (10-minute) pulse sequence was superior to that of contrast-enhanced CT.
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PMID:Hepatic metastases: randomized, controlled comparison of detection with MR imaging and CT. 331 94

In a prospective study the impact of ultrasound tomography in the recognition and exclusion, respectively, of liver diseases was investigated. 646 patients with a suspected liver disease were sonographed in real-time procedure. The investigator was familiar with the history as well as with clinical and lab findings before the examination was started. The sonography was performed before a laparoscopy, liver blind punktion, scintigraphy, angiography, computerized tomography. The diagnoses were confirmed by sufficient, comparable methods (see above) or operatively; they were supported by a follow-up for one year. While liver cysts, cystic livers, liver abscesses, haematomas, metastases (with a diameter of more than 10-20 mm), stasis liver, cirrhoses with portal hypertension and fatty livers could be diagnosed with a high rate of confidence by sonography, healthy livers and the following disorders could not exactly be separated by ultrasound: acute hepatitis, reactive hepatitis hepatoses, chronically persisting hepatitis, chronic active hepatitis, and livers with a low incorporation of fat.
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PMID:[Results of ultrasound tomography in the diagnosis of liver diseases]. 353 Jul 8


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