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Tips and tricks for the diagnosis and management of biliary stenosis-state of the art review

World Journal of Gastrointestinal Endoscopy 2021年第10期13卷 473-490页

作者： Giovanna Del Vecchio Blanco Michelangela Mossa Edoardo Troncone renato argirò Andrea Anderloni Alessandro Repici Omero Alessandro Paoluzi Giovanni Monteleone Department of Systems Medicine Gastroenterology UnitUniversity of Rome Tor VergataRome 00133Italy Department of Interventional Radiology University of Rome Tor VergataRome 00133Italy Digestive Endoscopy Unit Division of GastroenterologyHumanitas Research Hospital&Humanitas UniversityRozzano 20093Italy

Biliary stenosis may represent a diagnostic and therapeutic challenge resulting in a delay in diagnosis and initiation of therapy due to the frequent difficulty in distinguishing a benign from a malignant stricture.In such cases,the diagnostic flowchart includes the sequential execution of imaging techniques,such as magnetic resonance,magnetic resonance cholangiopancreatography,and endoscopic ultrasound,while endoscopic retrograde cholangiopancreatography is performed to collect tissue for histopathological/cytological diagnosis or to treat the stenosis by insertion of stent.The execution of percutaneous transhepatic drainage with subsequent biopsy has been shown to increase the possibility of tissue diagnosis after failure of the above techniques.Although the diagnostic yield of histopathology and imaging has increased with improvements in endoscopic ultrasound and peroral cholangioscopy,differential diagnosis between malignant and benign stenosis may not be easy in some patients,and strictures are classified as indeterminate.In these cases,a multidisciplinary workup including biochemical marker assays and advanced technologies available may speed up a diagnosis of malignancy or avoid unnecessary surgery in the event of a benign stricture.Here,we review recent advancements in the diagnosis and management of biliary strictures and describe tips and tricks to increase diagnostic yields in clinical routine.

关键词： Biliary stenosis Cholangioscopy Metal stent Endoscopic ultrasound Endoscopic ultrasound-guided fine needle aspiration Biliary stenosis treatment

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Safety and efficacy of DEM-TACE performed with drug-eluting microspheres smaller than 300μm in patients with HCC and TIPS

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Hepatoma Research 2022年第1期8卷 193-206页

作者： Pierleone Lucatelli Simone Zilahi De Gyurgyokai Gianluca De Rubeis renato argirò Simone Ciaglia Bianca Rocco Flaminia Ferri Simona Parisse Mariana Forlino Alessandro Cannavale FabrizioBasilico Pier Giorgio Nardis Mario Corona Vito Cantisani Carlo Catalano Vascular and Interventional Radiology Unit Department of Radiological Oncological and Anatomo-Pathological SciencesPoliclinico Umberto I Sapienza University of RomeViale Regina Elena 324Rome 00161Italy Department of Interventional Radiology San Camillo Forlanini HospitalCirconvallazione Gianicolense 87Rome 00152Italy Department of Imaging and Interventional Radiology Azienda Ospedaliera Universitaria Policlinico Tor VergataViale Oxford 81Rome 00133Italy Department of Translational and Precision Medicine Sapienza University of RomeViale Regina Elena 324Rome 00161Italy Department of Radiology Policlinico Umberto I Sapienza University of RomeViale Regina Elena 324Rome 00161Italy

Aim:Safety and efficacy evidence of drug-eluting-microspheres trans-arterial chemoembolization(DEM-TACE)in patients with hepatocellular carcinoma(HCC)and trans-jugular intrahepatic portosystemic shunt(TIPS)is lacking.The aim of this retrospective study was to report the safety and efficacy of DEM-TACE procedures performed with microspheres smaller than 300μm in patients with HCC and TIPS in a high-volume transplant center.Methods:Embolization was standardized by initiating DEM-TACE with microspheres smaller than 100μm,and if stasis was not achieved,adjunctive embolization with 100-300 or 200μm microspheres was administered.With regards to efficacy,the oncological response was evaluated and categorized according to mRECIST criteria at 1,3-6,9-12,and 15-18 months.Reporting the safety profile,detailed laboratory analysis was performed before,at 36-48 h,and 30-60 days after the procedure.Adverse events(AEs)were recorded;post-embolic syndrome was defined as the onset of fever/nausea/pain after the procedure.Late onset hepatobiliary complications were evaluated by follow-up imaging with computed tomography or magnetic resonance(CT/MR).Results:From December 2007 to November 2020,17 HCC patients(25 HCC nodules)with patent TIPS underwent 20 DEM-TACE.Embolization was performed only with microspheres smaller than 100μm in 3/20 DEM-TACE(15%);adjunctive embolization with 100-300 or 200μm microspheres was required in 17/20 DEMTACE(85%).Reported early AEs were post-embolic syndrome(9/20;45%)all of grade 1-2,late AEs were asymptomatic acute liver bile duct injury(2/20;10%),and in one case we observed hepatic abscess(1/20;5%)resulting in death due to sepsis.With regards to efficacy,the oncological response was evaluated and categorized according to mRECIST criteria.Complete response(CR)at 1,3-6,9-12,and 15-18 months was 52%,50%,50%,and 50%,respectively.Objective response(CR+partial response)at 1,3-6,9-12,and 15-18 months was 95%,71%,70%,and 50%,respectively.Conclusion:DEM-TACE with drug-eluting-microspheres smaller than 300μm can

关键词： HCC TIPS DEM-TACE CT MR

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3 T MRI对甲状旁腺腺瘤术前定位的诊断准确性:对比超声和99Tcm-sestamibi扫描

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国际医学放射学杂志 2019年第1期 122-123页

作者： R.argirò D.Diacinti B.Sacconi A.Iannarelli D.Diacinti C.Cipriani 张立斌 Department of Radiology Interventional Radiology UnitOspedale M.G. Vannini-Figlie di San Camillo

摘要目的对比US和99Tcm-sestamibi扫描,评估3 T MRI对原发性甲状旁腺功能亢进症（PHPT）病人甲状旁腺腺瘤（PTA）术前定位的诊断性能。方法前瞻性纳入57例

关键词：甲状旁腺腺瘤敏感度 PTA 特异度 PPV NPV Tc~m-sestamibi T MRI 术前定位

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CT引导下肺疾病活检专用介入机器人系统的临床初步应用:与常规人工操作技术比较

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国际医学放射学杂志 2015年第4期 390-391页

作者： M.Anzidei R.argirò A.Porfiri F.Boni M.Anile F.Zaccagna 俞翔 Department of Radiological Oncological and Anatomopathological Sciences-Radiologu-SapienzaUniveersity of Rome

摘要目的与常规人工操作技术比较,评价机器人系统在CT引导下肺活检中的应用效能。材料与方法将100例拟行CT引导下肺活检的病人随机分配到A组(机器人辅助操

关键词：人工操作机器人人工智能常规肺活检 CT

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伴原发性甲状旁腺功能亢进的甲状旁腺腺瘤病人的MRI表现:放射科医生在术前定位需要了解什么?

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国际医学放射学杂志 2016年第3期 321-322页

作者： B.Sacconi R.argirò Daniele Diacinti A.Iannarelli M.Bezzi C.Cipriani 蒋小露 Department of Radiological Sciences Oncology and PathologySapienza University

摘要目的采用3.0 T MR快速成像序列观察伴原发性甲状旁腺功能亢进(PHPT)的甲状旁腺腺瘤(PTA)病人的常见MRI表现。方法选取38例PHPT病人进行3 T MRI扫描,所有病人在超声和核素显像上均呈阳性表现,共发现46个腺瘤病灶。在增强检查前后,对... 详细信息

摘要目的采用3.0 T MR快速成像序列观察伴原发性甲状旁腺功能亢进(PHPT)的甲状旁腺腺瘤(PTA)病人的常见MRI表现。方法选取38例PHPT病人进行3 T MRI扫描,所有病人在超声和核素显像上均呈阳性表现,共发现46个腺瘤病灶。在增强检查前后,对病人行T2WI IDEAL-FSE和T1IDEAL序列扫描。甲状旁腺腺瘤5个常见征象为:(1)在T2序列上呈高信号;(2)均质或呈大理石样表现;(3)形态为细

关键词：原发性甲状旁腺功能亢进甲状旁腺腺瘤 MRI 病人

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