Liver transplantation is a method that allows treating of various liver pathological conditions. Interventional radiology (IR) focuses on oncology patients, primarily those with hepatocellular carcinoma. The importance of interventional radiology techniques is in preventing the progression of current liver disease in those patients awaiting liver transplantation and downstaging in patients with unresectable liver tumors to the stage where transplantation is possible. Chemoembolization (TACE), i.e., conventional transarterial chemoembolization (cTACE) or with drug particles (DEB-TACE), radioembolization (SIRT), BLAND embolization, radiofrequency ablation (RFA), and microwave ablation (MWA) are the most widely used IR methods in the treatment of liver cancer. cTACE is a form of TACE in which a high dose of cytostatic is injected into the feeding vessel and the tumor's microenvironment, and then the blood vessels that feed the tumor are embolized. DEB-TACE is a form of TACE in which a cytostatic bind to bead particles that gradually release the drug within the liver tumor itself after injection. BLAND embolization is an IR method of TACE based on ischemia of tumor tissue by IR procedure of embolization and occlusion of the feeding vessel that supplies the tumor, without the use of chemotherapeutics. Transarterial radioembolization is a method that uses endovascular techniques to bring radiospheres containing a radioactive substance near the tumor. Radiofrequency ablation (RFA) is an IR percutaneous method of treatment in which an RF needle inserted into a liver tumor releases heat that causes coagulation necrosis of tumor cells. MWA is an IR percutaneous method of treatment that uses molecules with an internal dipole moment, which move kinetic energy and then heat inside the tumor via a percutaneously inserted MWA needle into the tumor.
A hepatocellular carcinoma (HCC) is a primary liver malignancy, often arising in the setting of chronic liver disease. Incidence of this carcinoma is increasing at a great rate. Disease often manifests asymptomatically and to make the final diagnosis is often challenging. Screening of patients at risk is based on ultrasound (US) examinations, which in the setting of suspicion lesion findings often converts to multiphasic computed tomography (CT) and magnetic resonance imaging (MRI) procedures for advanced disease evaluation. The selection of treatment modality depends on tumor size and location, extrahepatic spread and subsequent liver disease. For years the first line of treatment was liver resection and transplantation. Locoregional therapy is a novel approach to diverse stages of HCC with good response and higher overall survival rates, especially in early stages. Transarterial chemoembolization (TACE) is the method of choice in patients with multifocal HCC and maintained liver function, unsuitable for surgical treatment. We present a patient with HCC in the setting of hepatitis C virus (HCV) infection, treated with combined methods of locoregional therapy.
Magnetic resonance imaging (MRI) is a sensitive and safe radiological method for breast and axillar lymph node imaging. MRI is widely used for diagnostics and follow-up of breast cancer candidates for neoadjuvant chemotherapy. MRI is used to assess tumor response to chemotherapy in these patients and help plan the type of surgical procedure needed after the therapy. Also, preoperative MRI changes the surgical approach in 11-16% of the cases and depicts the occult tumor in the contralateral breast in 3-4% of patients whose primary treatment is surgery.Several studies in recent years, some on more than a thousand patients, have shown usefulness of breast MRI for planning surgical approaches reducing the number of patients with positive resection margins, thus reducing the number of patients who need reoperation.In future, we should aim to include MRI of the breast as a diagnostic tool in more, if not all, patients diagnosed with breast cancer.
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