Screening for portopulmonary hypertension

Role of 18F-FDG PET-CT in initial staging of hepatocellular carcinoma and its impact on changing clinical decision

Background

Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide. Extrahepatic metastasis from HCC occurs in one third of patients with most common sites being the lungs, lymph nodes, bone, and adrenal glands. Various conventional imaging modalities like ultrasonography, computed tomography, magnetic resonance imaging, and bone scan are used in the diagnosis and staging of HCC. Recently, PET performed with fluoro-2-deoxy-d-glucose (FDG) has proved valuable in providing important tumor-related qualitative and quantitative metabolic information that is critical to the diagnosis and staging of the disease. This article aims to show the role of 18F-FDG PET-CT in the initial staging of HCC and its impact on changing clinical decision.

Main text

We discussed the previous studies on the ability of 18F-FDG PET-CT to detect HCC, vascular invasion, regional and distant metastasis. We also studied the relation between the histopathologic grading of HCC and its detectability by 18F-FDG PET-CT.

Conclusions

18F-FDG PET-CT has proved valuable in HCC staging and has a great impact on the clinical decision for HCC treatment.

Portopulmonary hypertension

Portopulmonary hypertension (PoPH) refers to the condition that pulmonary arterial hypertension (PAH) occur in the stetting of portal hypertension. The development of PoPH is thought to be independent of the severity of portal hypertension or the etiology or severity of liver disease. PoPH results from excessive vasoconstriction, vascular remodeling, and proliferative and thrombotic events within the pulmonary circulation that lead to progressive right ventricular failure and ultimately to death. Untreated PoPH is associated with a poor prognosis. As PoPH is frequently asymptomatic or symptoms are generally non-specific, patients should be actively screened for the presence of PoPH. Two-dimensional transthoracic echocardiography is a useful non-invasive screening tool, but a definitive diagnosis requires invasive hemodynamic confirmation by right heart catheterization. Despite a dearth of randomized, prospective data, an ever-expanding clinical experience shows that patients with PoPH benefit from therapy with PAH-specific medications including with endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and/or prostanoids. Due to high perioperative mortality, transplantation should be avoided in those patients who have severe PoPH that is refractory to medical therapy.