{"id":11495,"date":"2021-01-29T19:14:40","date_gmt":"2021-01-30T00:14:40","guid":{"rendered":"https:\/\/cornflowerblue-rail-980953.hostingersite.com\/?p=11495"},"modified":"2021-01-29T20:06:46","modified_gmt":"2021-01-30T01:06:46","slug":"whats-new-in-liver-imaging-portuguese-january-2021","status":"publish","type":"post","link":"https:\/\/staging-hub.acoredu.com\/pt-pt\/whats-new-in-liver-imaging-portuguese-january-2021\/","title":{"rendered":"What’s new in Liver Imaging (Portuguese) – January 2021"},"content":{"rendered":"

[embedyt] https:\/\/www.youtube.com\/watch?v=_PWoHWGFLzs[\/embedyt]<\/p>\n

\n

 <\/p>\n

F\u00cdGADO: US<\/strong><\/span><\/h3>\n

 <\/p>\n

Padr\u00f5es de realce de carcinoma hepatocelular pequeno (\u2264 30 mm) na ultrassonografia com contraste: Correla\u00e7\u00e3o com caracter\u00edsticas cl\u00ednico-patol\u00f3gicas.<\/span> <\/strong><\/h5>\n

Fan PL, Ding H, Mao F, et al.<\/p>\n

Eur J Radiol. Elsevier Ireland Ltd; 2020; 132.<\/p>\n

Dispon\u00edvel em: http:\/\/www.ejradiology.com\/article\/S0720048X20305301\/fu<\/a><\/p>\n

Palavras-chave:<\/strong> CEUS, CHC<\/p>\n

Pergunta cl\u00ednica:<\/strong> Quais s\u00e3o as implica\u00e7\u00f5es cl\u00ednicas de v\u00e1rios padr\u00f5es de realce que podem ser vistos no CEUS em pequenos CHCs menores ou iguais a 3 cm?<\/p>\n

O que foi feito:<\/strong> Padr\u00f5es de realce de pequenos CHC na ultrassonografia com contraste foram correlacionados com caracter\u00edsticas cl\u00ednico-patol\u00f3gicas.<\/p>\n

Como foi feito:<\/strong> Avalia\u00e7\u00e3o retrospectiva de 372 pequenos CHCs confirmados por patologia que foram submetidos a CEUS. As caracter\u00edsticas cl\u00ednico-patol\u00f3gicas que foram inclu\u00eddas na an\u00e1lise foram AFP s\u00e9rico, PIVKA-II, se o HCC era prim\u00e1rio ou recidivado, n\u00famero de tumores, diferencia\u00e7\u00e3o do tumor, tamanho do tumor, caracter\u00edsticas do par\u00eanquima hep\u00e1tico de fundo e invas\u00e3o microvascular.<\/p>\n

Achados e resultados:<\/strong> CHCs moderadamente ou mal diferenciados tiveram 96% de probabilidade de apresentar hiperrealce na fase arterial, enquanto CHC bem diferenciado teve 59% de probabilidade. A lavagem nas fases portal e tardia foi observada em 79% dos CHCs e teve alta correla\u00e7\u00e3o com o tamanho do tumor, raz\u00e3o de chances de 2,34, com CHCs maiores (2-3 cm) tendo uma propor\u00e7\u00e3o maior de lavagem do que aqueles <2 cm.<\/p>\n

Conclus\u00e3o:<\/strong> Os padr\u00f5es de realce de pequenos CHCs em CEUS foram significativamente correlacionados com o tamanho do tumor e a diferencia\u00e7\u00e3o do tumor entre todas as caracter\u00edsticas cl\u00ednico-patol\u00f3gicas.<\/p>\n

 <\/p>\n

Destrui\u00e7\u00e3o de microbolhas desencadeada por US para aumentar a resposta do carcinoma hepatocelular \u00e0 radioemboliza\u00e7\u00e3o transarterial: um ensaio cl\u00ednico piloto randomizado.<\/strong><\/span><\/h5>\n

Eisenbrey JR, Forsberg F, Wessner CE, et al.<\/p>\n

Radiologia. RSNA; 2020; 202321.<\/p>\n

Dispon\u00edvel em: http:\/\/pubs.rsna.org\/doi\/10.1148\/radiol.2020202321<\/a><\/p>\n

Palavras-chave:<\/strong> CEUS, TARE, UTMD<\/p>\n

Pergunta cl\u00ednica:<\/strong> Qual \u00e9 a seguran\u00e7a e efic\u00e1cia combinada da destrui\u00e7\u00e3o de microbolhas desencadeada por ultrassom (UTMD) e radioemboliza\u00e7\u00e3o transarterial (TARE) para o tratamento de CHC?<\/p>\n

O que foi feito:<\/strong> Ensaio cl\u00ednico piloto prospectivo randomizados com 28 participantes tratados com TARE, TARE seguido por UTMD 1-4 horas depois, e TARE seguido por UTMD 1-2 semanas depois.<\/p>\n

Como foi feito:<\/strong> a efic\u00e1cia do tratamento foi avaliada pelos crit\u00e9rios mRECIST, a an\u00e1lise comparativa foi feita com o teste U de Mann-Whitney, as diferen\u00e7as na preval\u00eancia da resposta do tumor foram avaliadas pelo teste exato de Fisher e as diferen\u00e7as nas curvas de sobrevida geral foram avaliadas por teste log-rank de Mantel-Cox.<\/p>\n

Achados e resultados:<\/strong> Nenhuma mudan\u00e7a significativa na temperatura, freq\u00fc\u00eancia card\u00edaca ou press\u00e3o arterial foi encontrada antes e depois do UTMD nos participantes do estudo. Quando avaliado 1 m\u00eas ap\u00f3s TARE, nenhuma altera\u00e7\u00e3o nos testes da fun\u00e7\u00e3o hep\u00e1tica foi observada nos bra\u00e7os de tratamento. A efic\u00e1cia do tratamento mostrou maior preval\u00eancia de resposta do tumor em participantes que se submeteram a ambos UTMD e TARE (93%) versus TARE sozinho (50%).<\/p>\n

Conclus\u00e3o \/ Implica\u00e7\u00f5es:<\/strong> UTMD e TARE mostraram-se n\u00e3o apenas seguros e vi\u00e1veis, mas tamb\u00e9m mostraram melhorar a resposta ao tratamento do CHC.<\/p>\n

 <\/p>\n

F\u00cdGADO: RM<\/strong><\/span><\/h3>\n

 <\/p>\n

Crit\u00e9rios auxiliares da resson\u00e2ncia magn\u00e9tica para observa\u00e7\u00f5es categorias 3 e 4 do LI-RADS: categoriza\u00e7\u00e3o aprimorada para indicar o risco de malignidade hep\u00e1tica.<\/strong> <\/span><\/h5>\n

Kim Y-Y, Choi J-Y, Kim SU, et al.<\/p>\n

Am J Roentgenol. ARRS; 2020; 215 (6): 1354\u20131362.<\/p>\n

Dispon\u00edvel em: https:\/\/www.ajronline.org\/doi\/10.2214\/AJR.20.22802<\/a><\/p>\n

Palavras-chave:<\/strong> RM, LI-RADS, crit\u00e9rios auxiliares<\/p>\n

Pergunta cl\u00ednica:<\/strong> Os crit\u00e9rios auxiliares do LI-RADS podem ajudar a estratificar o risco de malignidade entre as categorias 3 e 4?<\/p>\n

O que foi feito:<\/strong> as observa\u00e7\u00f5es hep\u00e1ticas que foram previamente caracterizadas como LR3 ou LR4 foram reavaliadas usando apenas as caracter\u00edsticas principais seguidas pelas caracter\u00edsticas auxiliares e, em seguida, analisadas para curvas de incid\u00eancia cumulativa de malignidade.<\/p>\n

Como foi feito:<\/strong> Estudo retrospectivo de 106 observa\u00e7\u00f5es hep\u00e1ticas. As caracter\u00edsticas da resson\u00e2ncia magn\u00e9tica foram comparadas usando equa\u00e7\u00f5es de estimativa generalizadas. As curvas de incid\u00eancia cumulativa para malignidade foram comparadas usando testes de log-rank com extens\u00e3o de reamostragem.<\/p>\n

Achados e resultados:<\/strong> A incid\u00eancia cumulativa de malignidade n\u00e3o diferiu entre as observa\u00e7\u00f5es de LR3 e LR4 quando levamos em considera\u00e7\u00e3o apenas as caracter\u00edsticas principais. No entanto, ap\u00f3s a aplica\u00e7\u00e3o de crit\u00e9rios auxiliares, a incid\u00eancia cumulativa de malignidade foi significativamente maior em observa\u00e7\u00f5es caracterizadas como LR4 do que naquelas como LR3.<\/p>\n

Conclus\u00f5es \/ implica\u00e7\u00f5es:<\/strong> O uso de crit\u00e9rios auxiliares \u00e9 essencial para categorizar corretamente as observa\u00e7\u00f5es hep\u00e1ticas em LR3 e LR4. O uso dos crit\u00e9rios maiores sozinhos n\u00e3o \u00e9 suficiente.<\/p>\n

 <\/p>\n

F\u00cdGADO: MISCEL\u00c2NEA<\/span> <\/strong><\/h3>\n

 <\/p>\n

Utilidade do 18<\/sup>F-FDG PET \/ CT e da TC multif\u00e1sica no Diagn\u00f3stico Diferencial do Carcinoma Hepatocelular e Carcinoma hepatocelular e colangiocarcinoma combinados.<\/span> <\/strong><\/h5>\n

Park JC, Park JG, Jung G-S, et al.<\/p>\n

J Korean Soc Radiol. 2020; 81 (6): 1424.<\/p>\n

Dispon\u00edvel em: https:\/\/jksronline.org\/DOIx.php?id=10.3348\/jksr.2019.0154<\/a><\/p>\n

Palavras-chave:<\/strong> CHC, colangiocarcinoma, PET, TC, valor diagn\u00f3stico<\/p>\n

Pergunta cl\u00ednica:<\/strong> O PET \/ CT pode diferenciar entre CHC-colangiocarcinoma combinado (cCHC-CCA) e CHC?<\/p>\n

O que foi feito:<\/strong> Compara\u00e7\u00e3o da taxa de positividade em PET \/ CT para CHC versus cCHC-CCA.<\/p>\n

Como foi feito:<\/strong> Estudo retrospectivo de 93 pacientes com CHC ou cCHC-CCA patologicamente confirmado que foram submetidos a TC e PET \/ CT. A TC foi feita com contraste venosa e curvas de realce din\u00e2micas foram constru\u00eddas. Todos os casos foram estratificados por tipo de padr\u00e3o de realce, entre tipo I (realce arterial precoce e lavagem tardia), tipo II (realce arterial precoce sem lavagem tardia) ou tipo III (hipovascular, apar\u00eancia infiltrativa ou realce perif\u00e9rico).<\/p>\n

Achados e resultados:<\/strong> O cCHC-CCAs teve uma taxa de PET \/ CT positiva mais alta (89%) do que CHC (61%), no geral. Essa diferen\u00e7a foi amplificada dentro do subconjunto de casos com um padr\u00e3o de realce do tipo II, em que 21% dos CHCs versus 80% dos cCHC-CCAs foram PET positivos.<\/p>\n

Conclus\u00f5es \/ Implica\u00e7\u00f5es:<\/strong> PET \/ CT pode ser \u00fatil na diferencia\u00e7\u00e3o entre cCHC-CCA e CHC, especialmente se um padr\u00e3o de realce do tipo II for observado.<\/p>\n

 <\/p>\n

Desempenho de diagn\u00f3stico de LI-RADS vers\u00e3o 2018, LI-RADS vers\u00e3o 2017 e crit\u00e9rios OPTN para carcinoma hepatocelular.<\/strong><\/span><\/h5>\n

Kierans AS, Song C, Gavlin A, et al.<\/p>\n

Am J Roentgenol. ARRS; 2020; 215 (5): 1085\u20131092.<\/p>\n

Dispon\u00edvel em: https:\/\/www.ajronline.org\/doi\/10.2214\/AJR.20.22772<\/a><\/p>\n

Palavras-chave:<\/strong> LI-RADS, RM, TC, CHC, OPTN, valor diagn\u00f3stico<\/p>\n

Pergunta cl\u00ednica:<\/strong> Como se comparam os desempenhos diagn\u00f3sticos para CHC (em resson\u00e2ncia magn\u00e9tica) do LIRADS v2018, LIRADS v2017 e os crit\u00e9rios da Rede de Aquisi\u00e7\u00e3o e Transplante de \u00d3rg\u00e3os (OPTN)?<\/p>\n

O que foi feito:<\/strong> as observa\u00e7\u00f5es hep\u00e1ticas consistentes com CHC por histopatologia ou imagem de acompanhamento foram atribu\u00eddas categorias com base em LIRADS v2017, LIRADS v2018 e OPTN.<\/p>\n

Como foi feito:<\/strong> a an\u00e1lise retrospectiva dessas 159 observa\u00e7\u00f5es de CHC foi feita de forma independente por tr\u00eas radiologistas abdominais diferentes.<\/p>\n

Achados e resultados:<\/strong> LIRADS v2018 categoria 5 e TIV tiveram maior sensibilidade para CHC do que OPTN classe 5 (64% v. 54%), mantendo a especificidade (97%). Da mesma forma, LIRADS v2018 categoria 5 e TIV tiveram maior sensibilidade do que LIRADS v2017 classe 5 (64% v. 55%), mantendo a especificidade (97%).<\/p>\n

Conclus\u00f5es \/ implica\u00e7\u00f5es:<\/strong> LIRADS v2018 teve maior sensibilidade para HCC do que LIRADS v2017 e OPTN sem sacrificar a especificidade.<\/p>\n","protected":false},"excerpt":{"rendered":"[embedyt] https:\/\/www.youtube.com\/watch?v=_PWoHWGFLzs[\/embedyt]   F\u00cdGADO: US   Padr\u00f5es de realce de carcinoma hepatocelular pequeno (\u2264 30 […]","protected":false},"author":3,"featured_media":2953,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[207],"tags":[],"class_list":["post-11495","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sem-categoria"],"yoast_head":"\nWhat's new in Liver Imaging (Portuguese) - 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