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Valutare i cambiamenti della presentazione ecografica (US) degli epatocarcinomi (HCC) diagnosticati presso la nostra UO di Medicina Interna in tre periodi:1993-98, 2003-2008,2013-18. Il Gruppo 1 (G1) (1993-1998) comprendeva 174 HCC, il Gruppo 2 (G2) (2003-08) 96, il Gruppo 3 (G3) (2013-2018) 102. Sono stati registrati età, sesso, markers HBV, HCV, uso di alcol, alfafetoproteina (AFP), test di funzionalità epatica, autoanticorpi, ferritinemia. La diagnosi di HCC in G2 e G3 è stata posta secondo le linee guida EASL, in G1 con istologia o citologia nel 40%, nel resto con multiple tecniche di imaging concordanti (ecografia, TC, TC con lipiodol, angiografia), livelli sierici di AFP>200 ng/ml. La presentazione US veniva classificata secondo Otho in: Singolo, Multipli, Diffusi (Dig. Liv. Dis. 43 (2011) 875–880). Nel gruppo 1: 11.5% dei pazienti risultava in sorveglianza, meno che nel G2 (66%) e nel G3 (76.4%) (p

OBJECTIVE: The objective of this study was to assess the long-term natural history of focal confluent fibrosis in cirrhotic liver with CT. MATERIALS AND METHODS: Two radiologists retrospectively reviewed in consensus 118 liver CT examinations in 26 patients (19 men, seven women; age range, 32-68 years; mean age, 50 years) performed over approximately 6 years. Helical CT scans were obtained before and 30-35 and 65-70 seconds after injection of 125-150 mL of contrast medium at a rate of 4-5 mL/s. Proof of cirrhosis was based on liver transplantation (n = 6), biopsy (n = 9), or imaging findings (n = 11). The number, location, and attenuation of fibrotic lesions and presence of trapped vessels were evaluated. Variation of hepatic retraction associated with the development of focal confluent fibrosis lesions was assessed using the ellipsoid volume formula and an arbitrary retraction index. RESULTS: Each radiologist identified 41 focal confluent fibrosis lesions. All lesions were identified by both radiologists. Twelve patients (46%) had a single lesion, 13 (50%) had two lesions, and one (4%) had three lesions. Thirty-four (83%) of 41 lesions were located in segment IV, VII, or VIII. Thirty-two lesions (78%) were hypoattenuating on unenhanced images, 25 lesions (61%) were hypoattenuating on hepatic arterial phase images, and 20 lesions (49%) were isoattenuating on portal venous phase images. Seven lesions (17%) were or became hyperattenuating at follow-up on portal venous phase images. Trapped vessels were found in six lesions (15%). The retraction index showed a significant increase over time (r = 0.423, p < or = 0.0001). CONCLUSION: The degree of capsule retraction associated with focal confluent fibrosis evolves with time and relates to the natural evolution of cirrhosis.

We report the neuroimaging findings in a group of systemic disorders with a common pathophysiological pattern of derangements in cerebral vascular autoregulatory mechanism producting potentially reversible brain lesions.We reviewed the brain CT and MR examinations of 14 patients with clinical diagnosis of vasculopathy not related to atherosclerosis or cardiogenic embolism. The patients were admitted at the onset of neurologic deficit and were affected with one of the following systemic disorders: thrombotic thrombocytopenic purpura (TTP, 6 cases), uremic encephalopathy (4 cases), eclampsia (2 cases), 1 chronic renal failure from systemic lupus erythematosus and 1 cyclosporin neurotoxicity. All patients underwent neuroimaging follow-up within 7-20 days of the onset of neurologic deficit and the start of anti-edema therapy.CT and MR findings were characterized by cortical-subcortical or deep brain lesions related to edema. Ten patients presented bilateral lesions, which were symmetric in 4 cases. Edema resolution was demonstrated on follow-up examinations after therapy in 4 patients (2 with eclampsia, 1 with TTP and 1 with uremic encephalopathy). The lesions showed no signs of regression in 10 patients.Brain lesions with a common pathogenesis from derangements in vascular autoregulatory mechanism--i.e., not due to atherosclerosis or cardiogenic embolism--should be properly and promptly recognized because they can be reversible and readily treatable.