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Complete spontaneous regression of giant focal nodular hyperplasia of the liver: Magnetic resonance imaging evaluation with hepatobiliary contrast media

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World Journal of Gastroenterology 2016年第47期22卷 10461-10464页

作者： Giuseppe Mamone Settimo Caruso Kelvin Cortis roberto miraglia Department of Diagnostic and Therapeutic Services IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies) Medical Imaging Department Mater Dei Hospital

Focal nodular hyperplasia(FNH) of the liver is a benign lesion occurring in 0.6%-3% of the general population that probably reflects a local hyperplastic response of hepatocytes to a vascular abnormality. Most lesions are diagnosed incidentally and the natural history of the disease remains largely unknown. It has been shown that most FNH remain stable, or even regress, over a long follow-up period. We present a patient with FNH of the liver who was followed up for 7 years. A 26-yearold woman with a 5-year history of oral contraceptive use was referred to our hospital in February 2005 for further examination of a liver tumour. The diagnosis of FNH was made using magnetic resonance(MR) imaging with hepatospecific contrast media; this technique allows a correct diagnosis, in particular distinguishing FNH from hepatic adenoma, avoiding an invasive procedure such as the lesion biopsy. After 7-year from the diagnosis, we observed the complete spontaneous regression of the lesion by enhanced MR scanning. In this patient, discontinuation of oral contraceptive use and two childbirths may have influenced the natural history of FNH. To our knowledge, in the English literature there is no report illustrating a complete regression of giant FNH but only studies of decreasing in size. The present case suggests that a young patient with giant FNH should be managed conservatively rather than by resection, because FNH has the potential for spontaneous regression.

关键词： Focal nodular hyperplasia Regression Magnetic resonance Oral contraceptives Pregnancy

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Imaging in liver transplantation

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World Journal of Gastroenterology 2009年第6期15卷 675-683页

作者： Settimo Caruso roberto miraglia Luigi Maruzzelli Salvatore Gruttadauria Angelo Luca Bruno Gridelli Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT)University of Pittsburgh Medical Center ItalyVia Tricomi 1Palermo 90127Italy Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT) University of Pittsburgh Medical Center ItalyVia Tricomi 1 Palermo 90127Italy

The aim of this study was to illustrate the role of noninvasive imaging tools such as ultrasonography,multidetector row computed tomography,and magnetic resonance imaging in the evaluation of pediatric and adult liver recipients and potential liver donors,and in the detection of potential complications arising from liver transplantation.

关键词： Complications Liver donor Liver transplantation Magnetic resonance Multi detector computed tomography

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Percutaneous transarterial embolization of extrahepatic arteroportal fistula

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World Journal of Gastroenterology 2006年第34期12卷 5562-5564页

作者： Gianluca Marrone Settimo Caruso roberto miraglia Ilaria Tarantino Riccardo Volpes Angelo Luca Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IsMeTT) Palermo Italy

Arteroportal fistula is a rare cause of prehepatic portal hypertension. A 44-year-old male with hepatitis virus C infection was admitted for acute variceal bleeding. Endoscopy showed the presence of large esophageal varices. The ultrasound revealed a mass near the head of pancreas, which was characterized at the color- Doppler by a turbulent flow, and arterialization of portal vein flow. CT scan of abdomen showed a large aneurysm of the gastroduodenal artery communicating into the superior mesenteric vein. The sinusoidal portal pressure measured as hepatic vein pressure gradient was normal, confirming the pre-hepatic origin of portal hypertension. The diagnosis of extrahepatic portal hypertension secondary to arteroportal fistula was established, and the percutaneous embolization was performed. Three months later, the endoscopy showed absence of esophageal varices and ascites. At the moment, the patient is in good clinical condition, without signs of portal hypertension.

关键词： Portal hypertension Arteroportal fistula Portal shunt Esophageal varices bleeding Embolization Interventional radiology Psudoaneurysm

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Transjugular intrahepatic portosystemic shunt with accidental diagnosis of persistence of the left superior vena cava

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World Journal of Gastroenterology 2010年第9期16卷 1158-1160页

作者： Ioannis Petridis roberto miraglia Gianluca Marrone Salvatore Gruttadauria Angelo Luca Giovanni Battista Vizzini Bruno Gridelli Department of Gastroenterology and Hepatology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center Department of Abdominal Surgery and Organ Transplantation Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center

Transjugular intrahepatic portosystemic shunt (TIPSS) is considered a valid therapeutic option for the treatment of portal hypertension and its *** guidelines for this procedure have already been established on the basis of the normal vascular anatomy and of various technical radiological *** some few rare cases,diagnosis of a congenital vascular anomaly can be made accidentally by interventional radiologists,making the procedure of the TIPSS placement extremely difficult or in some cases technically *** report describes a rare vascular malformation characterized by the absence of the right superior vena cava and persistence of the left superior vena cava in a patient with a diagnosis of advanced liver cirrhosis who needed a TIPSS placement in order to control refractory ascites.

关键词： Left superior vena cava persistence Liver cirrhosis Refractory ascites Transjugular intrahepatic portosystemic shunt

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A case of biliary stones and anastomotic biliary stricture after liver transplant treated with the rendez-vous technique and electrokinetic lithotritor

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World Journal of Gastroenterology 2008年第18期14卷 2920-2923页

作者： Marta Di Pisa Mario Traina roberto miraglia Luigi Maruzzelli Riccardo Volpes Salvatore Piazza Angelo Luca Bruno Gridelli Department of Gastroenterology IsMeTT UPMC Via Tricomi Palermo 90100 Italy Department of Radiology IsMeTT UPMC Via Tricomi 1 Palermo 90100 Italy Department of Hepatology IsMeTT UPMC Palermo 90100 Italy Civico Hospital Via Tricomi Palermo 90100 Italy Department of Radiology IsMeTT UPMC Palermo 90100 Italy Department of Surgery IsMeTT UPMC Palermo 90100 Italy

The paper studies the combined radiologic and endoscopic approach (rendez vous technique) to the treatment of the biliary complications following liver transplant. The "rendez-vous" technique was used with an electrokinetic lithotripter, in the treatment of a biliary anastomotic stricture with multiple biliary stones in a patient who underwent orthotopic liver transplant. In this patient, endoscopic or percutaneous transhepatic management of the biliary complication failed. The combined approach, percutaneous transhepatic and endoscopic treatment (rendez-vous technique) with the use of an electrokinetic lithotritor, was used to solve the biliary stenosis and to remove the stones. Technical success, defined as disappearance of the biliary stenosis and stone removal, was obtained in just one session, which definitively solved the complications. The combined approach of percutaneous transhepatic and endoscopic (rendez-vous technique) treatment, in association with an electrokinetic lithotritor, is a safe and feasible alternative treatment, especially after the failure of endoscopic and/or percutaneous trans-hepatic isolated procedures.

关键词： Biliary complications Liver transplant Endoscopic retrograde cholangiopancreatography Percutaneous TranshepatJc Cholangiography Percutaneous libhot^ipsy

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Interventional radiology procedures in adult patients who underwent liver transplantation

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World Journal of Gastroenterology 2009年第6期15卷 684-693页

作者： roberto miraglia Luigi Maruzzelli Settimo Caruso Mariapina Milazzo Gianluca Marrone Giuseppe Mamone Vincenzo Carollo Salvatore Gruttadauria Angelo Luca Bruno Gridelli Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT) University of Pittsburgh Medical CenterVia Tricomi 1 Palermo 90127Italy Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT) University of Pittsburgh Medical CenterVia Tricomi 1 Palermo 90127Italy

Interventional radiology has acquired a key role in every liver transplantation(LT)program by treating the majority of vascular and non-vascular post-transplant complications,improving graft and patient survival and avoiding,in the majority of cases,surgical revision and/or *** aim of this paper is to review indications,technical consideration,results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.

关键词： Liver transplantation Interventional radiology Complication Review Liver

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Efficacy of transcatheter embolization/chemoembolization (TAE/TACE) for the treatment of single hepatocellular carcinoma

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World Journal of Gastroenterology 2007年第21期13卷 2952-2955页

作者： roberto miraglia Giada Pietrosi Luigi Maruzzelli Ioannis Petridis Settimo Caruso Gianluca Marrone Giuseppe Mamone Giovanni Vizzini Angelo Luca Bruno Gridelli Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (IsMeTT).University of Pittsburgh Medical Center Italy

AIM:To investigate the efficacy of transcatheter embolization/chemoembolization (TAE/TACE) in cirrhotic patients with single hepatocellular carcinoma (HCC) not suitable for surgical resection and percutaneous ablation therapy. METHODS:A cohort of 176 consecutive cirrhotic patients with single HCC undergoing TAE/TACE was reviewed; 162 patients had at least one image examination (helical CT scan or triphasic contrastenhanced MRI) after treatment and were included into the study. TAE was performed with Lipiodol followed by Gelfoam embolization; TACE was performed with Farmorubicin prepared in sterile drip at a dose of 50 mg/m2,infused over 30 min using a peristaltic pump,and followed by Lipiodol and Gelfoam embolization. RESULTS:Patients characteristics were:mean age,62 years; male/female 117/45; Child-Pugh score 6.2 ± 1.1; MELD 8.7 ± 2.3; mean HCC size,3.6 (range 1.0-12.0) cm. HCC size class was ≤ 2.0 cm,n = 51; 2.1-3.0 cm,n = 35; 3.1-4.0 cm,n = 29; 4.1-5.0 cm,n = 22; 5.1-6.0 cm,n = 11; and > 6.0 cm,n = 14. Patients received a total of 368 TAE/TACE (mean 2.4 ± 1.7). Complete tumor necrosis was obtained in 94 patients (58%),massive (90%-99%) necrosis in 16 patients (10%),partial (50%-89%) necrosis in 18 patients (11%) and poor ( 6.0 cm,respectively. Kaplan-Mayer survival at 24-mo was 88%,68%,59%,59%,45%,and 53% for lesions of ≤ 2.0,2.1-3.0,3.1-4.0,4.1-5.0,5.1-6.0,and > 6.0 cm,respectively. CONCLUSION:Our study showed that in cirrhotic patients with single HCC smaller than 6.0 cm,TAE/TACE produces complete local control of tumor in a significant proportion of patients. TAE/TACE is an effective therapeutic option in patients with single HCC not suitable for surgical resection or percutaneous ablation therapies. Further studies should investigate if the new available embo

关键词： Transcatheter embolization/chemoembolization Hepatocellular carcinoma

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Predictive factors of tumor response to trans-catheter treatment in cirrhotic patients with hepatocellular carcinoma:A multivariate analysis of pre-treatment findings

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World Journal of Gastroenterology 2007年第45期13卷 6022-6026页

作者： roberto miraglia Giada Pietrosi Luigi Maruzzelli Ioannis Petridis Settimo Caruso Gianluca Marrone Giuseppe Mamone Giovanni Vizzini Angelo Luca Bruno Gridelli Department of Radiology Mediterranean Institute for Transplantation and A dvanced Specialized Therapies(IsMeTT)University of Pittsburgh Medical Center Palermo90127Italy Department of Hepatology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) University of Pittsburgh Medical Center Palermo 90127 Italy Department of Transplantation Surgery Mediterranean Institute for Transplantation and AdvancedSpecialized Therapies (IsMeTT) University of Pittsburgh MedicalCenter Palermo 90127 Italy

AIM： To elucidate the pre-treatment clinical and imaging findings affecting the tumor response to the transcatheter treatment of unresectable hepatocellular carcinoma （HCC）. METHODS： Two hundred cirrhotic patients with HCC received a total of 425 transcatheter treatments. The tumor response was evaluated by helical CT and a massive necrosis （MN） was defined as a necrosis 〉 90%. Twenty-five clinical and imaging variables were analyzed： uninodular/multinodular HCC, unilobar/bilobar, tumor capsula, hypervascular lesion, portal vein thrombosis, portal hypertension, ascites, platelets count, aspartate transaminases/alanine transaminases （AST/ALT）, alfa- fetoprotein （AFP）〉 100, AFP 〉 400, serum creatinine, virus hepatitis C （VHC） cirrhosis, performance status, age, Okuda stage, ChUd-Pugg stage, sex, CLIP （Cancer of the Liver Italian Program） score, serum bilirubin, constitutional syndrome, serum albumine, prothrombin activity, BCLC （Barcelona Clinic Liver Cancer） stage. Prognostic factors of response were subjected to univariate analysis and thereafter, when significant, to the multivariate analyses. RESULTS： On imaging analysis, complete response wasobtained in 60 （30%） patients, necrosis 〉 90% in 38 （19%） patients, necrosis 〉 50% in 44 （22%） patients, and necrosis 〈 50% in 58 （29%） patients. Ninety-eight （49%） of the 200 patients were considered to have a MN. In univariate analysis, significant variables （P 〈 0.01） were： uninodular tumor, unilobar, tumor size 2-6 cm, CLIP score 〈 2, absence of constitutional syndrome, and BCLC stage 〈 2. In a multivariate analysis, the variables reaching statistical significance were： presence of tumor capsule （P 〈 0.0001）, tumor size 2-6 cm （P 〈 0.03）, CLIP score 〈 2 （P 〈 0.006）, and absence of constitutional syndrome （P 〈 0.03）. Kaplan-Mayer cumulative survival at 12 mo was 80% at 24 mo was 56%. MN was associated with a longer survival （P 〈 0.0001）. CONCLUSION： MN after transcatheter treatment is more common in the presence of tumor

关键词： Hepatocellular carcinoma Trans-catheterembolization/chemoembolization Tumor response

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Transition process in children with chronic liver diseases:what is the challenging point?

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 854-856页

作者： Anna Di Sessa Giusy Capasso Paola Tirelli Emanuele miraglia Del Giudice Pierluigi Marzuillo Department of Woman Childand General and Specialized SurgeryUniversity of Campania Luigi VanvitelliNaplesItaly

Pediatric chronic liver diseases encompass a wide spectrum of hepatopathies with a relevant health medical and financial burden(1,2).In addition to inherited disorders(e.g.,Alagille syndrome,metabolic disorders,etc.),there are numerous chronic liver conditions including metabolic dysfunction-associated steatotic liver disease(MASLD)and autoimmune liver diseases affecting morbidity,quality of life,and life expectancy of these young patients(3,4).To complicate matters,the exact prevalence of childhood chronic liver diseases is still unknown since their asymptomatic course especially in the early stages but increasing rates are reported worldwide(1,5,6).Moreover,management of these chronic conditions represents a great challenge for clinicians as it requires a lifelong multi-disciplinary approach(1).Worthy of note,advances in the knowledge of pathophysiological mechanisms underlying liver diseases greatly improved their natural history with increased survival rates into adulthood(1,3).Given that,adult hepatologists are increasingly dealing with most of these conditions(3).

关键词： Chronic liver diseases children transition adult

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Interplay between metabolic dysfunction-associated fatty liver disease and renal function: An intriguing pediatric perspective

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World Journal of Gastroenterology 2024年第15期30卷 2081-2086页

作者： Michele Nardolillo Fabiola Rescigno Mario Bartiromo Dario Piatto Stefano Guarino Pierluigi Marzuillo Emanuele miraglia del Giudice Anna Di Sessa Department of Woman Child and of General and Specialized SurgeryUniversitàdegli Studi della Campania“Luigi Vanvitelli”Naples 80138Italy

Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant ***,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver disease”(MAFLD)to underscore the close association of fatty liver with metabolic abnormalities,thereby highlighting the cardiometabolic risks(such as metabolic syndrome,type 2 diabetes,insulin resistance,and cardiovascular disease)faced by these patients since *** recently,this term has been further replaced with metabolic associated steatotic liver *** is worth noting that emerging evidence not only supports a close and independent association of MAFLD with chronic kidney disease in adults but also indicates its interplay with metabolic ***,comparable pediatric data remain *** the progressive and chronic nature of both diseases and their prognostic cardiometabolic implications,this editorial aims to provide a pediatric perspective on the intriguing relationship between MAFLD and renal function in childhood.

关键词： Metabolic(dysfunction)associated fatty liver disease Renal Function Children Obesity

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