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[Magnetic resonance in surgical planning in hepatocarcinomas].

The diagnostic accuracy of Magnetic Resonance Imaging (MRI) in the preoperative staging of unifocal hepatocellular carcinoma (HCC) was investigated and compared with that of ultrasonography (US) and Computed Tomography (CT). Eighteen patients with focal HCCs underwent MRI, CT and US scans before surgery. In all cases the histopathologic diagnosis was made with CT-guided fine-needle aspiration biopsy (FNAB). The diagnostic accuracy of each imaging modality was investigated with the assessment of three parameters thought to be of the utmost importance for surgical planning, i.e., lesion unifocality, the presence of a capsule and finally vascular involvement. MRI proved to be more sensitive than CT in demonstrating both lesion unifocality (100% vs. 94.4%) and the presence of a capsule (100% vs. 71.4%). In 2 of 18 patients some blood vessels were involved, which was clearly demonstrated only by MRI, CT missing it. Both MRI and CT had 100% specificity in the detection of a perilesional capsule and of vascular involvement. To conclude, MRI exhibited higher diagnostic accuracy than US and CT, thus confirming its major role in the preoperative staging of unifocal HCCs.

Biopsy, Needle↗

PubMedDate not supplied

Hepatic incidentaloma. Retrospective analysis of 35 cases.

At present imaging techniques and laboratory tests are employed very extensively to investigate obscure visceral symptoms. During these investigations it can happen that a liver lesion is discovered. This lesion, solid or cystic, when discovered in the liver of a healthy person, is called hepatic incidentaloma. This study analyzes retrospectively the diagnostic and therapeutic management of a series of 35 patients, with an asymptomatic lesion of the liver discovered incidentally. These patients had been observed over a period of five years (1988-1993). There were 22 benign lesions and 13 hepatic cell carcinomas (HCCs), three of which discovered in patients with non diagnosed cirrhosis. The presence of a risk factor for HCC in the past history of the patient with a hepatic incidentaloma strongly suggests that the lesion is malignant (p < 0.05). The average age of patients with malignant lesions was significantly higher than that of patients with benign lesions (65 vs 45 years; p < 0.01). Symptoms and/or signs did not help to distinguish between patients with benign and malignant lesions. Serum alkaline phosphatase (SAP) and alpha-fetoprotein levels were significantly higher in patients with malignancies (p < 0.01). A certain diagnosis was achieved preoperatively in 85% of the cases. In the remaining 15%, a definitive diagnosis was reached only after surgery. Surgical or percutaneous treatment was required in 80% of the cases. In conclusion, although in a minority of cases, surgery is still required for definitive diagnosis of a hepatic incidentaloma.

Adolescent↗