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array:24 [ "pii" => "S2173510717300526" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2017.07.003" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "973" "copyright" => "SERAM" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2017;59:414-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 91 "formatos" => array:2 [ "HTML" => 79 "PDF" => 12 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0033833817300693" "issn" => "00338338" "doi" => "10.1016/j.rx.2017.04.007" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "973" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2017;59:414-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 112 "formatos" => array:2 [ "HTML" => 90 "PDF" => 22 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Papel de la embolización selectiva intraarterial en los tumores hepáticos benignos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "414" "paginaFinal" => "421" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Role of selective intra-arterial embolization in benign liver tumors" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1640 "Ancho" => 2157 "Tamanyo" => 517022 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Adenoma. A y B) Estudio de tomografía computarizada con contraste en fase arterial (A) y portal (B) que muestra una lesión compatible con adenoma en lóbulo hepático izquierdo (LHI). C) Resonancia magnética (RM) T1 GRE SG sin contraste. Se observa masa en el LHI con focos centrales de hemorragia (flecha). D) RM T1 GRE SG con contraste en fase arterial donde se observa la lesión hipervascularizada con el vaso aferente (cabeza de flecha) dependiente de la arteria hepática izquierda. E-G) Arteriografía y embolización selectiva de la lesión con alcohol de polivinilo de 500-700<span class="elsevierStyleHsp" style=""></span>μ. H) Corte histológico de la pieza quirúrgica que muestra hepatocitos diferenciados con normal relación núcleo-citoplasma, carente de espacios porta.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.D. Ferrer Puchol, C. La Parra Casado, A. Cervera Araez, R. Sala López, E. Esteban Hernández, A. Cremades Mira, R. Ramiro Gandia" "autores" => array:7 [ 0 => array:2 [ "nombre" => "M.D." "apellidos" => "Ferrer Puchol" ] 1 => array:2 [ "nombre" => "C. La" "apellidos" => "Parra Casado" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Cervera Araez" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Sala López" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Esteban Hernández" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Cremades Mira" ] 6 => array:2 [ "nombre" => "R." "apellidos" => "Ramiro Gandia" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173510717300526" "doi" => "10.1016/j.rxeng.2017.07.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510717300526?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833817300693?idApp=UINPBA00004N" "url" => "/00338338/0000005900000005/v1_201709080040/S0033833817300693/v1_201709080040/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S217351071730054X" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2017.07.005" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "969" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2017;59:422-30" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 45 "formatos" => array:2 [ "HTML" => 32 "PDF" => 13 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Virtual cystoscopy, computed tomography urography and optical cystoscopy for the detection and follow-up for bladder cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "422" "paginaFinal" => "430" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cistoscopia virtual, urografía por tomografía computarizada y uretrocistoscopia óptica en el diagnóstico y el seguimiento del cáncer de vejiga" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 700 "Ancho" => 1400 "Tamanyo" => 97338 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Examples of OUC images. (A) Correlation with lesion adjacent to the vesical neck from <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> (arrow). (B) Example of OUC in a different patient with another papillomatous lesion (arrow) and two visible planar lesions as erythematous changes in the mucosa (asterisk).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Ibáñez Muñoz, I. Quintana Martínez, A. Fernández Militino, D. Sánchez Zalabardo, L. Sarria Octavio de Toledo, R. Cozcolluela Cabrejas" "autores" => array:6 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Ibáñez Muñoz" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Quintana Martínez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Fernández Militino" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Sánchez Zalabardo" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Sarria Octavio de Toledo" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Cozcolluela Cabrejas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833817300541" "doi" => "10.1016/j.rx.2017.04.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833817300541?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351071730054X?idApp=UINPBA00004N" "url" => "/21735107/0000005900000005/v1_201709230142/S217351071730054X/v1_201709230142/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510717300502" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2017.07.001" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "977" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2017;59:401-13" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 28 "formatos" => array:2 [ "HTML" => 14 "PDF" => 14 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Percutaneous sclerotherapy of pediatric lymphatic malformations: Experience and outcomes according to the agent used" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "401" "paginaFinal" => "413" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento percutáneo de las malformaciones linfáticas en edad pediátrica: experiencia y resultados según el esclerosante empleado" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 3933 "Ancho" => 2522 "Tamanyo" => 337872 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">In order to verify whether the location of the lymphatic malformation (A), the type (B) or sclerosant agent used (C) influenced the success of the therapy, one Pearson's chi-square statistical analysis was conducted. We obtained one statistically significant difference (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.4) (D) in the success of the sclerotherapy procedure based on the types of LM, being this statistically significant difference larger in the macrocystic types.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Gallego Herrero, V. Navarro Cutillas" "autores" => array:2 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Gallego Herrero" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Navarro Cutillas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833817300760" "doi" => "10.1016/j.rx.2017.04.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833817300760?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510717300502?idApp=UINPBA00004N" "url" => "/21735107/0000005900000005/v1_201709230142/S2173510717300502/v1_201709230142/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Role of selective intra-arterial embolization in benign liver tumors" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "414" "paginaFinal" => "421" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.D. Ferrer Puchol, C. La Parra Casado, A. Cervera Araez, R. Sala López, E. Esteban Hernández, A. Cremades Mira, R. Ramiro Gandia" "autores" => array:7 [ 0 => array:4 [ "nombre" => "M.D." "apellidos" => "Ferrer Puchol" "email" => array:1 [ 0 => "mferrer@hospital-ribera.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "La Parra Casado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Cervera Araez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Sala López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "E." "apellidos" => "Esteban Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "Cremades Mira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "R." "apellidos" => "Ramiro Gandia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitario La Ribera, Alzira, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía General y Digestiva, Hospital Universitario La Ribera, Alzira, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario La Ribera, Alzira, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de la embolización selectiva intraarterial en los tumores hepáticos benignos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1235 "Ancho" => 2667 "Tamanyo" => 542430 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Focal nodular hyperplasia. (A) and (B) MRI study with hepatospecific contrast (gadoxetic acid) in the hepatocellular phase showing one lesion in the left liver lobe (LLL) that happens to be compatible with focal nodular hyperplasia. (C) Biopsy study showing ductular proliferation in the fibrous septa-liver trabeculae junction. (D) and (F) Arteriography and final findings after selective embolization with 500–700<span class="elsevierStyleHsp" style=""></span>μm PAPs leading to the devascularization of the lesion. (G) Surgical piece. The surgical intervention took place 5 days later without any complications.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Benign liver tumors are usually diagnosed through imaging modalities. Most cases are incidental and symptomatic findings. A percentage of these tumors, especially large tumors, present with pain, hemorrhages, or palpable masses during the abdominal examination. In these cases, management and surgical removal is a recommendation accepted by an experts committee.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The selective intra-arterial embolization (SIE) is one therapeutical option that allows us to control the acute bleeding, reduce intraoperative hemorrhages, and in cases of unresectable tumors, it may even control de symptoms.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2–5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The goal of this study is to present the cases diagnosed and treated in our hospital and analyze the results obtained.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><p id="par0020" class="elsevierStylePara elsevierViewall">It is a retrospective study including 5 women diagnosed with symptomatic benign tumors that required treatment (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">All patients reported abdominal pain, or palpable mass and the first diagnostic approach was through an ultrasound; then their lesions were characterized through computed tomography (CT) scan, or magnetic resonance imaging (MRI) with contrast.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cases were assessed together by the unit of general surgery, and the unit of radiology and interventional radiology, that decided the course to follow.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patient#1 shown in the table required a lesion biopsy procedure that was performed percutaneously, and confirmed the diagnosis of focal nodula hyperplasia. In all the cases presented, intra-arterial embolization procedures were decided prior to the surgery in order to minimize the bleeding and facilitate the removal of the tumor, except for liver adenomatosis that required an urgent intra-arterial embolization procedure due to hypovolemic shock (case 3, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Approval from the hospital ethics committee was not required since the preoperative embolization is an already accepted technique.</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients were informed on the procedure and signed a prior informed written consent, except for the patient with adenomatosis whose embolization was performed urgently.</p><p id="par0045" class="elsevierStylePara elsevierViewall">All patients received antibiotic therapy in one single intravenous (IV) dose of 1500<span class="elsevierStyleHsp" style=""></span>mg of cefuroxime during the surgical act. Conscious sedation was administered through one IV dose of 12<span class="elsevierStyleHsp" style=""></span>mg of midazolam, one IV dose of 50<span class="elsevierStyleHsp" style=""></span>mg of pethidine hydrochloride, and one IV dose of 4<span class="elsevierStyleHsp" style=""></span>mg of ondansetron.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The right common femoral artery was approached with the Seldinger technique using one 4<span class="elsevierStyleHsp" style=""></span>F vascular introducer sheath with hydrophilic guidewire (Terumo Europa<span class="elsevierStyleSup">®</span>, Leuven, Belgium); one 5<span class="elsevierStyleHsp" style=""></span>F pig-tail catheter was used to perform one abdominal aortography for the assessment of tumor vascularization; and Cobra 2, or Simmons 2 catheters were used to perform one selective arteriography of the arterial branches nurturing the tumor, and once the arterial map was obtained, the artery irrigating the lesion was navigated using the 2.7/2.9<span class="elsevierStyleHsp" style=""></span>F Progreat catherer (Terumo Europa, Leuven, Belgium) with one 0.021<span class="elsevierStyleHsp" style=""></span>in. hydrophilic guidewire in order to be as selective as possible. Once the nutrient arteries could be identified, they were embolized using 500–700<span class="elsevierStyleHsp" style=""></span>μm polyvinyl alcohol particles (PAP) (Esfera Bead Block<span class="elsevierStyleSup">®</span>, Biocompatibles UK limited, Survey, UK), and then the nutrient artery was closed using Tornado<span class="elsevierStyleSup">®</span> coils (Cook Medical INC, Bloomington, USA) to make sure that tumor vascular exclusion was complete. The surgical procedure took place 4–7 days after the embolization.</p><p id="par0055" class="elsevierStylePara elsevierViewall">After the surgical procedure, absolute rest time was indicated for the next 24<span class="elsevierStyleHsp" style=""></span>h and all post-embolization syndromes were managed individually.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">After the embolization, all patients suffered from post-embolization syndrome with nausea and abdominal pain that was controlled with the administration of painkillers and antiemetic drugs (50<span class="elsevierStyleHsp" style=""></span>mg of pethidine hydrochloride in 100<span class="elsevierStyleHsp" style=""></span>ml of saline solution to be IV administered in 4<span class="elsevierStyleHsp" style=""></span>h, and 4<span class="elsevierStyleHsp" style=""></span>mg of IV ondansetron every 8<span class="elsevierStyleHsp" style=""></span>h). No case presented with fever, and symptoms resolved after 48<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The patient with liver adenomatosis initially presented with acute abdominal pain due to the presence of one intraparenchymatous hemorrhage in the lesion, and hypovolemic shock that required urgent embolization that controlled the hemorrhage and achieved haemodynamic stabilization. The bilobal distribution of the lesions required such a resection that the liver function reserve would be jeopardized, so a decision was made to move on with just clinical follow-up.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The surgical procedure after the embolization was completed in 4–7 days. In all patients intervened (6 out of 7) one segmentectomy or hepatectomy procedure was performed adapted to the topographical location of the lesion. In all the cases, surgery took place without any incidents, and exeresis was facilitated by prior vascular control and embolization. The postoperative progression of the patients was satisfactory and without incidents.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Benign liver tumors are a common finding in the overall population; they are described in up to 9 per cent of the population, although most of them are asymptomatic or incidental.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In asymptomatic cases, the recommendations published in the clinical guidelines for the management of benign liver tumors take different levels of evidence into consideration for the different types of tumors that exist.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The possibility of performing one SIE procedure is well established in cases of active bleeding,<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6–9</span></a> but it is not standardized as a preoperative option, although there are some papers published on this regard. Statistically significant studies still need to be conducted before we see changes in these guidelines. The SIE procedure with particles occludes the tumor parenchyma, while the coils close the nutrient arteries.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">10–13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The most common benign tumors and the indication for embolization in our casuistry are described now.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Cavernous hemangiomas are common benign liver tumors. Eighty per cent are found in women and up to 40 per cent may be multiple. They are considered congenital vascular malformations that grow due to ectasia with arterial vascular supply.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> Most are small, asymptomatic and do not require treatment; they are usually diagnosed incidentally through radiological imaging modalities such as ultrasounds, CT scans, and MRIs. Hemangiomas >10<span class="elsevierStyleHsp" style=""></span>cm<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,3,6</span></a> are considered giant hemangiomas and they may be symptomatic due to mass effect, pain secondary to capsular distension, or necrosis. On rare occasions they cause major complications such as the Kassabach–Merritt syndrome (KMS), where there is consumption coagulopathy; another serious complication are intraabdominal hemorrhages due to rupture of the hemangioma, that may be spontaneous or due to trauma, or biopsy.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,6</span></a> Although it is rare, ruptured hemangiomas have high mortality rates (35 per cent).<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> The risk of rupture is associated with the size of the lesion, especially if the tumor is located on the liver surface, or the patient has already been treated with prolongued therapies with corticosteroids.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,7,11,14</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In cases of symptomatic giant hemangiomas, and KMS, it is the responsibility of a multidisciplinary committee to plan the management of the lesions. No randomized studies confirm that surgery is more beneficial than conservative management. The SIE procedure is a more established recommendation as conservative management, or prior to surgery, that still has a low level of evidence.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,3,15</span></a> In our patients, the two hemangiomas were giant and causing abdominal pain that limited the activities of their daily lives. After achieving the diagnosis through imaging modalities and reaching the consensus of the multidisciplinary committee, surgical removal was the decision made, with prior SIE procedure, since it was believed that it would facilitate surgery and minimize the chances of suffering intraoperative hemorrhages. The arteriography prior to therapy showed the typical vascularization (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> The surgical procedure was conducted four days after the embolization without any complications, ending in the patients’ recovery and disappearance of the symptoms reported.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Focal nodular hyperplasia (FNH) is the second most common benign liver tumor. They are usually incidental findings with no potential malignancy, and whose surgical resection is not usually indicated.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,3,16</span></a> It is common in 30–50 year old women in the form of 5<span class="elsevierStyleHsp" style=""></span>cm single lesions that, sometimes, can be 15<span class="elsevierStyleHsp" style=""></span>cm in size. They are well-established non-encapsulated lobulated tumors characterized by one fibrovascular central scar with arterial vascular supply.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> The ultrasound, CT scan, and MRI are usually sufficient to achieve dignosis,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> but if the tumor is not well established, or if it is symptomatic, the clinical guidelines recommend a biopsy.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> Given that the female patient of our study was asymptomatic and complained of a “feeling of an abdominal mass”, one percutaneous biopsy was performed that confirmed the presence of focal nodular hyperplasia, which led to its surgical resection after assessment by the multidisciplinary committee; this decision was backed up by the existence of isolated cases already published in the medical literature of intralesional hemorrhages and ruptures,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> and because of the possibility of performing one SIE procedure as a therapeutical option if surgery was too risky, or there were contraindications.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The arteriographic findings in the FNH show centrifugal arteries stemming from the center of the lesion in a “spoke wheel pattern” and one drainage vein coming directly from such radial arteries<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">In our patient, the embolization was conducted without any complications, and exeresis was conducted 5 days later without any intraoperative incidents. Today the patient shows no symptoms whatsoever.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Adenomas are rare benign liver tumors usually found in women who use oral contraceptives, while in men they are associated with the use of anabolic steroids.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,3,13</span></a> Other risk factors are glycogen storage disease, familial polyposis, and obesity.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> Most cases present as single masses and they are usually 5–10<span class="elsevierStyleHsp" style=""></span>cm in size, although they can grow as much as 30<span class="elsevierStyleHsp" style=""></span>cm.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Liver adenomas present as well established masses with one pseudocapsule, and are made up of hepatocytes, a high content in fat and glycogen, and are separated by dilated sinusoids, without biliary ducts or portal triad, which distinguishes them from the FNH; also they are irrigated by peripheral arterial blood vessels<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> that have a higher risk of rupture and bleeding.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,13</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">According to the genomic analysis, liver adenomas may be categorized into four different groups (seen in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) that show the chances of malignization in every subgroup. The risk of complications is associated with size, and the chances of hemorrhage increase in tumors >5<span class="elsevierStyleHsp" style=""></span>cm, of superficial location, and when growth is >20 per cent.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> In cases of acute bleeding, the SIE procedure is the recommended therapeutical option. In cases of large size plus symptoms, surgical resection is advised, being the SIE procedure recommended to reduce the bleeding and degree of resection.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,3</span></a> The three cases presented had to do with large sizes, were symptomatic, and located in the left liver lobe, thus meeting the requirements of left hepatectomy, that was performed 4, 5, and 7 days after the embolization without complications (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Fifty per cent of patients with liver adenomas present as multinodular disease. Liver adenomatosis, that used to be defined by the presence of more than 10 adenomas and considered an entity in itself,<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13,19</span></a> is now defined as multiple liver adenomas<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> because counting the real number of tumors was almost impossible.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> The clinical presentation, risk of hemorrhage and tumor malignization are not any different from those of single adenomas, being the risk posed by the largest adenoma the one taken into consideration.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,20</span></a> Our patient (of foreign origin) initially presented with hypovolemic shock due to bleeding of her largest lesion, and required urgent embolization that stabilized her.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The clinical guidelines recommend the resection of unilobar lesions<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a>; in the aforementioned patient, surgery was not feasible due to bilobar liver spreading (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The liver transplant is proposed in cases of bilobar disease and underlying liver disease.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> Our patient rejected this possibility, travelled to her home country and contact was lost.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">We consider the preoperative embolization of benign liver lesions one useful tool for perioperative management, always with the approval of the multidisciplinary committee. We are aware of the limitations of this study such as the low number of cases studied and the absence of follow-up in liver adenomatosis.</p><p id="par0150" class="elsevierStylePara elsevierViewall">As a conclusion, we suggest that intra-arterial embolization with particles in benign asymptomatic liver tumors provides good control of the bleeding in the acute phase and reduces the risk of intraoperative hemorrhages during laparotomy.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Authors contribution</span><p id="par0155" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0160" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study: MDFP, ACA, CLC, EEH, RSL, and ACM.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0165" class="elsevierStylePara elsevierViewall">Study Idea: MDFP, ACA, CLC, EEH, RSL, ACM, and RRG.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0170" class="elsevierStylePara elsevierViewall">Study Design MDFP, ACA, CLC, RSL, ACM, and RRG.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0175" class="elsevierStylePara elsevierViewall">Data Mining: MDFP, ACA, CLC, EEH, RSL, and ACM.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0180" class="elsevierStylePara elsevierViewall">Data Analysis and Interpretation: MDFP, ACA, CLC, RSL, ACM, and RRG.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0185" class="elsevierStylePara elsevierViewall">Statistical Analysis: N/A.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0190" class="elsevierStylePara elsevierViewall">Reference: MDFP, ACA, and CLC.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0195" class="elsevierStylePara elsevierViewall">Writing: MDFP, ACA, and CLC.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9.</span><p id="par0200" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks: MDFP, ACA, CLC, EEH, RSL, ACM, and RRG.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10.</span><p id="par0205" class="elsevierStylePara elsevierViewall">Approval of final version: MDFP, ACA, CLC, EEH, RSL, ACM, and RRG.</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of human and animal subjects</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that no experiments with human beings or animals have been performed while conducting this investigation.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confidentiality of data</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors confirm that in this article there are no data from patients.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors confirm that in this article there are no data from patients.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interests</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres905081" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec885516" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres905080" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec885517" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors contribution" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-09-18" "fechaAceptado" => "2017-04-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec885516" "palabras" => array:4 [ 0 => "Therapeutic embolization" 1 => "Arterial embolization" 2 => "Liver tumor" 3 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec885517" "palabras" => array:4 [ 0 => "Embolización terapéutica" 1 => "Embolización arterial" 2 => "Tumor hepático" 3 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To present cases of symptomatic benign liver tumors diagnosed and treated with intra-arterial embolization before surgery.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present the cases of 7 patients diagnosed with symptomatic benign liver tumors that required treatment: 1 focal nodular hyperplasia, 2 giant cavernous hemangiomas, 1 hepatic adenomatosis, and 3 hepatic adenomas.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Once the feeding arteries were identified, tumors were embolized with polyvinyl alcohol particles (500<span class="elsevierStyleHsp" style=""></span>μm–700<span class="elsevierStyleHsp" style=""></span>μm) and then the feeding artery was plugged with coils if there was an arterial pedicle to ensure the total vascular exclusion of the tumor. The surgical intervention took place 4–7 days after embolization.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">All 7 patients were women (age range, 23–74 years); presurgical intra-arterial embolization was done in 6. In 1 patient with adenomatosis, embolization was done to control intraparenchymal hepatic hemorrhage. In the 6 patients who underwent surgery, the tumor was completely excised and no intraoperative bleeding events or postoperative complications occurred.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Provided there is a consensus among the multidisciplinary team, embolization is a useful option in the perioperative management of giant and/or symptomatic benign liver tumors.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Presentar los casos de tumores hepáticos benignos sintomáticos diagnosticados y tratados con embolización intraarterial previa a la cirugía. Describimos la técnica y analizamos los resultados obtenidos.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Presentamos 7 pacientes diagnosticadas de tumores benignos sintomáticos que requirieron tratamiento: 1 hiperplasia nodular focal, 2 hemangiomas cavernosos gigantes, 1 adenomatosis hepática y 3 adenomas hepáticos.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Una vez identificadas las arterias nutricias de cada tumor se embolizaron con partículas de PVA de 500 a 700 micras y posteriormente se cerró la arteria nutricia con coils si presentaban pedículo arterial para asegurar la exclusión vascular total del tumor. La intervención quirúrgica se realizó de 4 a 7 días después de la embolización.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los 7 casos eran mujeres con un rango de edad de 23 a 74 años. En 6 pacientes se realizó la embolización intraarterial prequirúrgica. En 1 caso, de adenomatosis, la embolización fue para control de una hemorragia intraparenquimatosa hepática. En las 6 pacientes intervenidas se realizó una exéresis tumoral completa y no tuvieron eventos hemorrágicos intraoperatorios ni ulteriores complicaciones.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La embolización de los tumores hepáticos benignos gigantes y/o sintomáticos es una opción terapéutica útil para el manejo perioperatorio, siempre consensuado en un comité multidisciplinar.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Ferrer Puchol MD, La Parra Casado C, Cervera Araez A, Sala López R, Esteban Hernández E, Cremades Mira A, et al. Papel de la embolización selectiva intraarterial en los tumores hepáticos benignos. Radiología. 2017;59:414–421.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1135 "Ancho" => 2000 "Tamanyo" => 282875 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Dynamic liver computed tomography study in arterial (A), portal (B), and late (C) phases, where the typical behaviour of globular uptake with centripetal filling of hemangiomas may be identified. (D) and (E) Arteriography (D), and selective embolization of the hemangioma with 500–700<span class="elsevierStyleHsp" style=""></span>μm polyvinyl alcohol particles (PAP) using one Progreat<span class="elsevierStyleSup">®</span> microcatheter and one coil in the nutrient blood vessel (E), resulting in the absence of vascularization as a final finding.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1235 "Ancho" => 2667 "Tamanyo" => 542430 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Focal nodular hyperplasia. (A) and (B) MRI study with hepatospecific contrast (gadoxetic acid) in the hepatocellular phase showing one lesion in the left liver lobe (LLL) that happens to be compatible with focal nodular hyperplasia. (C) Biopsy study showing ductular proliferation in the fibrous septa-liver trabeculae junction. (D) and (F) Arteriography and final findings after selective embolization with 500–700<span class="elsevierStyleHsp" style=""></span>μm PAPs leading to the devascularization of the lesion. (G) Surgical piece. The surgical intervention took place 5 days later without any complications.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1640 "Ancho" => 2157 "Tamanyo" => 517022 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Adenoma. (A) and (B) Computed tomography study with contrast in the arterial (A) and portal (B) phases showing one lesion compatible with adenoma in the left liver lobe (LLL). (C) Magnetic resonance imaging (MRI) T1-weighted GRE FS without contrast. Presence of one mass in the LLL with central foci of hemorrhage (arrow). (D) RM T1 GRE FS with contrast in the arterial phase showing one hypervascularized lesion with the afferent blood vessel (arrowhead) associated with the left liver artery. (E) and (G) Arteriography, and selective embolization of the lesion with 500–700<span class="elsevierStyleHsp" style=""></span>μm PAP. (H) Histological cut of the surgical piece showing differentiated hepatocytes with normal nucleus to cytoplasm ratio and absence of portal spaces.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1130 "Ancho" => 2243 "Tamanyo" => 295213 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">(A) and (C) Computed tomography scan without contrast (A) and with IV contrast in arterial (B) and portal (C) phases showing multiple lesions compatible with adenomas in a 23-year-old woman who presented with hemoperitoneum and hypovolemic shock. (D) and (E) Arteriography (D) and selective embolization of the major lesion (E). The largest lesion was located in the right liver lobe and was causing the bleeding. The largest lesion was embolized with 500–700<span class="elsevierStyleHsp" style=""></span>μm PAP and coil placement in the nutrient artery.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">FNH: focal nodular hyperplasia; RLL: right liver lobe; LLL: left liver lobe; F: female; PAP: polyvinyl alcohol particles.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"># \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical presentation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Size (cm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Embolization \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Final diagnosis \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LLL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">FNH \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RLL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PAP<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>coils \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cavernous hemangioma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain<br>Hypovolemic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RLL<br>LLL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PAP<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>coils \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Liver adenomatosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LLL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cavernous hemangioma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain<br>Vomits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LLL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Liver adenoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LLL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Liver adenoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LLL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Liver adenoma \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1522028.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Patients diagnosed with symptomatic benign tumors who required therapy.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Types \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type 1 adenoma \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type 2 adenoma \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type 3 adenoma \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type 4 adenoma \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Molecular type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HNFα<span class="elsevierStyleInf">1</span> mutation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inflammatory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">β-Catenin mutation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unclassifiable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Percentage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30–40 per cent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40–55 per cent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10–20 per cent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5–10 per cent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Characteristics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Familial DM<br>Prominent<br>Steaosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Obesity, metabolic syndrome, alcohol use, teleangiectasia type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Common in males<br>High risk of malignancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Without any specific findings or mutations \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1522029.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Modified from the European Association for the Study of the Liver (EASL).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Classification of hepatocellular adenomas based on genomic analysis.<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => 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