ospedale evangelico internazionale - home - hcc•elastography •diffusion wieghted imaging...
TRANSCRIPT
![Page 1: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/1.jpg)
Giovanni TurtuliciSS di Ecografia InterventisticaOspedale Evangelico IGnternazionale
‐
GE ‐
Castelletto
SC di Diagnostica per Immagini ed Ecografia Interventistica( Dir. Enzo Silvestri)
www.oeige.org
HCCHCC
EVOLUZIONE DELLAEVOLUZIONE DELLATECNOLOGIA ECOGRAFICATECNOLOGIA ECOGRAFICA
S.C. Diagnostica per Immagini ed Ecografia Interventistica – Ospedale Evangelico Internazionale - Genova
![Page 2: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/2.jpg)
Cirrosi biliareCirrosi biliareprimitivaprimitiva
ColangiteColangitesclerosantesclerosante
primitivaprimitiva
Epatite CEpatite CEpatite BEpatite B EpatiteEpatiteautoimmuneautoimmuneSteatoepatiteSteatoepatite
nonnonalcolicaalcolica
EpatiteEpatitealcolicaalcolicaEmocromatosiEmocromatosi
MorboMorbodi Wilsondi Wilson
DeficitDeficitdi alfadi alfa
11--antitripsinaantitripsina
AmiloidosiAmiloidosi
CIRROSICIRROSI
![Page 3: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/3.jpg)
IMAGINGIMAGING
ECOGRAFIAECOGRAFIATCTCRMRM
RX DIRETTO ADDOMERX DIRETTO ADDOME
ARTERIOGRAFIA SELETTIVAARTERIOGRAFIA SELETTIVA
DIAGNOSTICA RADIOISOTOPICADIAGNOSTICA RADIOISOTOPICA
![Page 4: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/4.jpg)
ECOGRAFIAECOGRAFIAIMAGING DI I LIVELLO NELLA IMAGING DI I LIVELLO NELLA
PATOLOGIA ADDOMINALEPATOLOGIA ADDOMINALE
a)a) Basso Basso costocosto
b)b) DiffusaDiffusa
c)c) VeloceVeloce esecuzioneesecuzione
d)d) No No RadiazioniRadiazioni
TROPPO OPERATORE DIPENDENTE !?
TROPPO OPERATORE DIPENDENTE !?
![Page 5: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/5.jpg)
ULTRASOUND
![Page 6: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/6.jpg)
VARIABILITÀ INTEROSSERVATORE NOTEVOLMENTE RIDOTTA SE SI USA STESSO APPARECCHIO E STESSE MODALITÀ DI MISURAZIONE PER I VARI PARAMETRI:
PBV -VELOCITA MEDIA PORTALE ANGOLO <55 O MENOPRF 4 kHzFILTRO PARETE 100HzMEDIA DI ALMENO 3 MISURAZIONI
L.BOLONDI et al.HEPATOLOGY 1995 Feb;21(2):428-33
![Page 7: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/7.jpg)
• TIPIZZAZIONE •• PERFUSIONE
• TEMPI DI TRANSITO
CEUS
![Page 8: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/8.jpg)
SONOELASTOGRAPHY
RREAL EAL TTIME TISSUE IME TISSUE SONOSONOEELASTOGRAPHYLASTOGRAPHY
-- SSHEAR HEAR WWAVEAVE ELASTOGRAPHYELASTOGRAPHYSSISSIARFIARFIFIBROSCANFIBROSCAN
![Page 9: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/9.jpg)
FIBROSCAN
![Page 10: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/10.jpg)
ARFI Acoustic Radiation Force Impulse
YOUNG’MODULE: E=3XV2 (KPa)
F1=1,2 m/s F2= 1,4 m/s F3= 1,6 m/s F4= 1,8 m/s
ARFI = m/sec
![Page 11: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/11.jpg)
ARFI ARFI
L’ imaging con ARFI è un metodo promettente per la valutazione della fibrosi nell’epatite virale cronica, con accuratezza diagnostica comparabile a quella della TE.
M.Friedrich-Rust et al.Radiology: Volume 252: n.2 – Aug 2009
![Page 12: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/12.jpg)
FUSION IMAGINGFusione di immagini RM/TC con ecografia
Un sistema di sensori e campi magnetici consente la perfetta sovrapposizione delle immagini in tempo reale
![Page 13: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/13.jpg)
FUSION IMAGING
![Page 14: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/14.jpg)
•CONVENTIONAL CONTRAST‐ ENHANCEMENT
•DOUBLE CONTRAST‐ENHANCEMENT
•ELASTOGRAPHY
•DIFFUSION WIEGHTED IMAGING
•PERFUSION IMAGING
•SPECTROSCOPY 31P 1
H 13
C 19
F
MAGNETIC RESONANCE
![Page 15: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/15.jpg)
US - LESIONI FOCALI
1. INDIVIDUAZIONE (DETECTION)2. ANALISI MORFOSTRUTTURALE (ECOSTRUTTURA)3. DIMENSIONI 4. VASCOLARIZZAZIONE MACROCIRCOLO (CD-PD)
TIPIZZAZIONE ?TIPIZZAZIONE ?
![Page 16: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/16.jpg)
INDIVIDUAZIONE
• Segmenti poco accessibili
• Ecostruttura disomogenea(pseudonodulare/nodulare)
• Ecostruttura accentuata (steatosi-fibrosi)
![Page 17: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/17.jpg)
• Segmenti poco accessibili
• Ecostruttura disomogenea(pseudonodulare/nodulare)
• Ecostruttura accentuata (steatosi-fibrosi)
INDIVIDUAZIONE
![Page 18: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/18.jpg)
• Segmenti poco accessibili
• Ecostruttura disomogenea(pseudonodulare/nodulare)
• Ecostruttura accentuata (steatosi-fibrosi)
INDIVIDUAZIONE
![Page 19: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/19.jpg)
SEMEIOTICA ECOGRAFICANODULINODULI
![Page 20: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/20.jpg)
ECOSTRUTTURA MACROVASCOLARIZZAZIONE (CD-PD)
NO TIPIZZAZIONE !
DynamicDynamic--ceMRIceMRI
TIPIZZAZIONETIPIZZAZIONE
valutazione MICROCIRCOLO
4phase4phase--CT CT CEUSCEUS
![Page 21: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/21.jpg)
Video registration
Timer
Dedicated software (Power Modulation, Pulse Inversion)
Contrast side/side
CEUS
![Page 22: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/22.jpg)
![Page 23: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/23.jpg)
CIRROSIDefinizione: epatopatia cronica caratterizzata da necrosi parenchimale diffusa, fibrosi e rigenerazione nodulare del parenchima stesso
Anatomia Patologica: micronodulare (noduli<3mm), macronodulare (>3 mm fino a parecchi cm)
![Page 24: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/24.jpg)
CIRROSI
NODULINODULI
• Noduli di Rigenerazione ( LR )
• Noduli DisplasticiLGDNHGDN
• Nodulo in Nodulo
• HCC ( nei vari gradi di differenziazione)
![Page 25: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/25.jpg)
HCCHCC
![Page 26: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/26.jpg)
![Page 27: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/27.jpg)
![Page 28: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/28.jpg)
Dysplastic
nodules
in liver
cirrhosis: imaging J.H.Lim,B.I.Choi
Abdominal
Imaging
2002, 27:17‐128
•
arterie anomale
– LGDN 18%
–HGDN 53 %
–HCC 92 %
LA QUANTIFICAZIONE ARTERIOSA PUO ESSERE UNO STRUMENTO DI DIAGNOSI PRECOCE
![Page 29: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/29.jpg)
The Vascular
Profile
of regenerative
and Dysplastic
Nodules
of The Cirrhotic
Liver: Implications
for
Diagnosis
and Classification
M.Roncalli
et
Al. HepatologyVol
30,No 5,1999
CD31 CD31 unita capillariunita capillari aSMAaSMA unpairedunpaired arteriesarteries
![Page 30: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/30.jpg)
Ultrasound Guided Fine Feedle Biopsy of Early Hepatocelluar Carcinoma in Cirrhosis.Multicentre
Study.Caturelli et all.Gut 2004;53:1356-1362
688 noduliN > 30mm (94,9 %) HCC21< N < 30 (97,1 %) HCC
![Page 31: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/31.jpg)
![Page 32: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/32.jpg)
ASSLD AISF
![Page 33: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/33.jpg)
Diagnosis
of Hepatic
Nodules
20 mm or Smaller
in Cirrhosis:Prospective Validation
of the Noninvasive
Diagnostic
Criteria
for
Hepatocellular
Carcinoma
A Forner
J.Bruix
Hepatology, January
2008
•
Noduli con vascolarizzazione atipica possono essere HCC•
HCC > 2 cm invasione pericapsulare, vascolare e noduli
satelliti•
Attualmente nessuna metodica permette diagnosi
precoce
Il futuro: •
Strumenti basati sull’ immunostochimica
(HSP70,CAP2)
•
valutazione genetica•
profilo proteico sierico
ed istologico
Oltre: biopsia !!!
![Page 34: Ospedale Evangelico Internazionale - Home - HCC•ELASTOGRAPHY •DIFFUSION WIEGHTED IMAGING •PERFUSION IMAGING •SPECTROSCOPY 31P 1 H ... Caturelli et all.Gut 2004;53:1356-1362](https://reader034.vdocuments.site/reader034/viewer/2022050110/5f484077b3acf43dfc1697ef/html5/thumbnails/34.jpg)
S.C. Diagnostica per Immagini ed Ecografia Interventistica – Ospedale Evangelico Internazionale - Genova
GRAZIE