Tuberculosis is a disease whose incidence has increased principally as a consequence
of HIV infection and use of immunosuppressive drugs. The abdomen is the most common
site of extrapulmonary tuberculosis. It may be confused with several different
conditions such as inflammatory bowel disease, cancer and other infectious diseases.
Delay in the diagnosis may result in significantly increased morbidity, and therefore
an early recognition of the condition is essential for proper treatment. In the
present essay, cases with confirmed diagnosis of abdominal tuberculosis were assessed
by means of computed tomography and magnetic resonance imaging, demonstrating the
involvement of different organs and systems, and presentations which frequently lead
radiologists to a diagnostic dilemma. A brief literature review was focused on
imaging findings and their respective prevalence.
Most malignant liver tumors are represented by hepatocellular carcinoma and
cholangiocarcinoma; however a variety of other uncommon hepatic lesions might also be
found. Common lesions such as hemangioma, focal nodular hyperplasia and metastases
are well known and have already been extensively documented in the literature. The
diagnosis of typical hepatic lesions may be done with some reliability by means of
several imaging methods; on the other hand, uncommon lesions normally represent a
diagnostic challenge for the radiologist. In this first part of the study, the
authors will approach five uncommon liver tumors - angiosarcoma, angiomyolipoma,
cystadenoma/biliary carcinoma, epithelioid hemangioendothelioma, and fibrolamellar
hepatocellular carcinoma -, describing their main characteristics and image findings
with focus on computed tomography and magnetic resonance imaging.
Recent studies have demonstrated that the use of paramagnetic hepatobiliary contrast
agents in the acquisition of magnetic resonance images remarkably improves the
detection and differentiation of focal liver lesions, as compared with extracellular
contrast agents. Paramagnetic hepatobiliary contrast agents initially show the
perfusion of the lesions, as do extracellular agents, but delayed contrast-enhanced
images can demonstrate contrast uptake by functional hepatocytes, providing further
information for a better characterization of the lesions. Additionally, this
intrinsic characteristic increases the accuracy in the detection of hepatocellular
carcinomas and metastases, particularly the small-sized ones. Recently, a
hepatobiliary contrast agent called gadolinium ethoxybenzyl dimeglumine, that is
simply known as gadoxetic acid, was approved by the National Health Surveillance
Agency for use in humans. The authors present a literature review and a practical
approach of magnetic resonance imaging utilizing gadoxetic acid as contrast agent,
based on patients' images acquired during their initial experiment.
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