O termo "má notícia" designa qualquer informação transmitida ao paciente ou a seus familiares que implique, direta ou indiretamente, alguma alteração negativa na vida destes. Por ser uma tarefa tão estressante, muitos médicos a evitam ou a realizam de maneira inadequada. Esse fato traz inúmeras consequências negativas para o paciente e seus familiares. Embora seja objeto de estudo em diversos cursos de Medicina em nível internacional, o tema ainda é pouco abordado por professores e estudantes no contexto brasileiro. O protocolo Spikes descreve de maneira didática seis passos para comunicar más notícias. Esses passos foram utilizados em aula para alunos do terceiro semestre do curso de Medicina da Universidade Estadual do Ceará. Em seguida, os alunos avaliaram o método por meio de perguntas abertas. De maneira geral, foi considerado um modelo válido, apesar de serem consideradas possíveis limitações, como a necessidade de ser individualizado e adaptado a cada situação.

Background and Aims Most of the published studies about the diagnostic accuracy of gadoxetic acid‐enhanced magnetic resonance (EOB‐MR) for the non‐invasive diagnosis of hepatocellular carcinoma (HCC) have had a retrospective design. Thus, we aimed to prospectively evaluate the diagnostic accuracy of EOB‐MR for the non‐invasive diagnosis of HCC in nodules ≤2 cm detected by screening ultrasound (US) in patients with cirrhosis. Methods Between July 2012 and October 2015, 62 consecutive asymptomatic Child‐Pugh A‐B cirrhotic patients with newly US‐detected solitary nodules between 1 and 2 cm were prospectively included in the study. Hepatic extracellular contrast‐enhanced MR (ECCE‐MR) followed by EOB‐MR were obtained in less than 1‐month interval. Two independent radiologists blindly reviewed the EOB‐MR studies, and the diagnosis of HCC was assigned when the lesion showed arterial enhancement followed by portal venous phase washout and/or hypointensity on the hepatobiliary phase (HBP). The final HCC diagnosis was made by ECCE‐MR according to the accepted non‐invasive criteria, or by biopsy in lesions with atypical vascular profile. Results Final diagnoses were as follows: HCC (n = 41), intrahepatic cholangiocarcinoma (n = 2), colorectal metastases (n = 1) and benign conditions (n = 18). The sensitivity and specificity of EOB‐MR for HCC diagnosis were 56.1% (95% CI: 39.7‐71.5) and 90.5% (95% CI: 69.6‐98.8), respectively, while sensitivity of ECCE‐MR was 63.4% (95% CI: 46.9‐77.9). The low rate of hypointense HCCs in the HBP and suboptimal liver uptake of contrast agent justify the low sensitivity of EOB‐MR for HCC diagnosis. Conclusion EOB‐MR does not surpass the diagnostic accuracy of ECCE‐MR for non‐invasive diagnosis of HCC in nodules ≤2 cm in cirrhotic patients.

Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with distinct morphological and biological manifestations, the liver being the main organ affected by its metastases. However, primary hepatic involvement is quite rare. Hepatic NENs can have a variety of radiological presentation forms and can therefore mimic other lesions, making their diagnosis challenging. Nonetheless, certain imaging aspects allow NENs to be included among the main differential diagnoses of hepatic lesions and can guide the search for an extrahepatic primary site when the probable diagnosis is metastases.

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Cholangiopathies are chronic diseases that affect the bile ducts, comprising a heterogeneous group of progressive and potentially fatal entities. The diagnosis of these diseases is a great challenge for radiologists because of the overlapping of their clinical, biochemical, and imaging findings. Nevertheless, identifying the precise etiology is crucial, given that the therapeutic options are distinct and influence the prognosis of the patient. The purpose of this review article is to discuss some of the non-neoplastic causes of cholangiopathies and to provide a useful diagnostic algorithm.