R Vilana

University of Barcelona, Barcino, Catalonia, Spain

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Publications (97)538.21 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionIn selected patients, radiofrequency ablation (RFA) is a well-established treatment for hepatocellular carcinoma (HCC). However, subcapsular or lesions close to adjacent viscera preclude a percutaneous approach. In this setting laparoscopic-RFA (LRFA) is a potential alternative. The aim of this study was to analyse the safety and feasibility of LRFA in patients with HCC.Patients and Methods Retrospective study of patients with HCC meeting strict inclusion criteria who underwent LRFA at a single Institution from December 2000 to March 2013.ResultsForty-one patients underwent 42 LRFA of 51 nodules. The median size of the nodule was 2.5 (range 1.2–4.7) cm. Thirty-one tumours were subcapsular and 17 located near the gallbladder. Major complications occurred in 17 patients. The initial complete response (ICR) rate was 94% and was lower among tumours located adjacent to the gallbladder. At the end of the follow-up period, the sustained complete response (SCR) rate was 70% and was lower in tumours adjacent to the gallbladder while increased for subcapsular tumours. The 1-, 3- and 5-year overall survival rate was 92.6%, 64.5% and 43%, respectively.ConclusionLRFA of HCC is safe, feasible and achieves excellent results in selected patients. LRFA should be the first-line technique for subcapsular lesions as it minimizes the risk of tumoural seeding and improves ICR. Proximity to gallbladder interferes in treatment efficacy (lower rate of ICR and lower rate of SCR).
    HPB 05/2015; 17(5). DOI:10.1111/hpb.12379 · 2.68 Impact Factor
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    Alejandro Forner · Ramón Vilana · Manel Solé · Jordi Bruix ·

    Journal of Hepatology 02/2015; 62(6). DOI:10.1016/j.jhep.2015.02.016 · 11.34 Impact Factor
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    ABSTRACT: Staging and prognosis assessment are critical steps in the management of patients with hepatocellular carcinoma. This cancer is a complex disease usually associated with chronic liver disease, and any attempt to assess the prognosis should consider tumor burden, degree of liver function impairment and evaluation of cancer-related symptoms. In addition, for any staging system to be meaningful it has to link staging with treatment indication and this should be based on robust scientific data. Currently, the only proposal that serves both aims is the Barcelona Clinic Liver Cancer (BCLC) staging system. It divides patients into very early/early, intermediate, advanced and end-stage. Early stage HCC patients should be considered for potentially curative options such as resection, transplantation and ablation. Patients at intermediate stage benefit from chemoembolization, while patients at an advanced stage or who cannot benefit of options of higher priority have sorafenib as standard of care. Finally, patients at end-stage should receive best supportive care.
    Baillière&#x027 s Best Practice and Research in Clinical Gastroenterology 10/2014; 28(5). DOI:10.1016/j.bpg.2014.08.002 · 3.48 Impact Factor
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    ABSTRACT: Background & aims: Current guidelines recommend diagnostic work-up for nodules >1cm detected during screening for hepatocellular carcinoma (HCC). This implies that patients with benign conditions may undergo unnecessary evaluation and those with small nodules may be intervened too early, leading to overdiagnosis. Since increased arterial vascularization is the hallmark of malignancy, its detection by contrast-enhanced ultrasound (CEUS) could become the signal to proceed with diagnosis confirmation. The aim was to assess if HCCs <2 cm without arterial hyperenhancement by baseline CEUS have a benign evolutionary profile, suggesting that diagnosis and invasive treatment could be delayed until detection of an overt malignant profile, associated with increased vascularization. Methods: We prospectively included 168 cirrhotic patients with a newly detected solitary nodule of 5-20mm by screening ultrasonography. MRI, CEUS and fine needle biopsy (FNB) were performed and if no confident diagnosis was obtained, patients were closely followed to rule out HCC. Final diagnosis was: HCC (n = 119), cholangiocarcinoma (n = 3), neuroendocrine tumour (n = 1) and benign lesions (n = 45). Results: CEUS did not detect contrast hyperenhancement in the arterial phase in 55 cases (34%). Eighteen out of these 55 nodules were diagnosed as HCC. Non-CEUS hyperenhanced HCCs were more frequently well-differentiated than CEUS-hyperenhanced HCCs (p < 0.004). Fourteen patients were treated with ablation and 4 with resection. Ten (55.6%) patients experienced tumour recurrence after treatment, mostly distant, confirming their overt malignant profile. Conclusions: Absence of contrast hyperenhancement on CEUS during the arterial phase in nodules <2 cm in a cirrhotic liver does not predict a less malignant profile. Accordingly, priority for diagnostic work-up and treatment should not differ according to contrast profiles on CEUS.
    Journal of Hepatology 08/2014; 62(1). DOI:10.1016/j.jhep.2014.08.028 · 11.34 Impact Factor
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    ABSTRACT: Objective To assess the value of contrast-enhanced ultrasound (CEUS) in the absence of hepatic artery signal on Doppler ultrasound (DUS) in the immediate postoperative period after liver transplant. Methods This prospective study included 675 consecutive liver transplants. Patients without hepatic artery signal by DUS within 8 days post-transplant were studied with CEUS. If it remained undetectable, a thrombosis was suspected. In patent hepatic artery, a DUS was performed immediately after CEUS; if low resistance flow was detected, an arteriography was indicated. Patients with high resistance waveform underwent DUS+/CEUS follow-up. Arteriography was indicated when abnormal flow persisted for more than 5 days or liver dysfunction appeared. Results Thirty-four patients were studied with CEUS. In 11 patients CEUS correctly diagnosed hepatic artery thrombosis. In two out of 23 non-occluded arteries, a low resistance flow lead to a diagnosis of stenosis/proximal thrombosis. Twenty-one patients had absence of diastolic flow, which normalized in the follow-up in 13 patients. In the remaining eight patients, splenic artery steal syndrome (ASS) was diagnosed. Conclusions CEUS allows us to avoid invasive tests in the diagnostic work-up shortly after liver transplant. It identifies the hepatic artery thrombosis and points to a diagnosis of ASS. Key Points • CEUS is useful in the diagnostic work-up shortly after liver transplant • CEUS identifies the hepatic artery thrombosis with reliability • There is little information about DUS and CEUS findings in the ASS • DUS and CEUS offer functional information useful in the diagnosis of ASS
    European Radiology 08/2014; 25(1). DOI:10.1007/s00330-014-3377-5 · 4.01 Impact Factor

  • Journal of Hepatology 04/2012; 56:S292-S293. DOI:10.1016/S0168-8278(12)60756-9 · 11.34 Impact Factor
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    ABSTRACT: To prospectively assess the diagnostic accuracy of the incorporation of additional magnetic resonance imaging (MRI) parameters in those based on contrast enhancement pattern for the diagnosis of solitary nodules between 5 and 20mm, detected during surveillance in patients with cirrhosis. Between November 2003 and January 2010, we prospectively included 159 cirrhotic patients with a newly detected solitary nodule between 5 and 20mm in diameter by screening ultrasonography (US). Hepatic MRI and fine-needle biopsy were performed in all patients. Final diagnoses were hepatocellular carcinoma (HCC) (n=103), other malignant lesions (intrahepatic cholangiocarcinoma/metastases) (n=4), and benign lesions (n=52). The specific enhancement pattern (arterial enhancement followed by washout) yielded a sensitivity and specificity of 58.3% and 96.4%, respectively. Peritumoral capsule was present in 43 HCC and in 2 non-HCC lesions. Intralesional fat was detected in 24 nodules; 5 nodules were non-HCC. Finally, the presence of both capsule and fat was observed in 10 cases, all of them HCC (100% specificity), but all of them also displayed the specific enhancement pattern, thus adding no sensitivity or specificity. Conclusive non-invasive diagnosis of HCC in cirrhosis should be based only on the contrast enhancement pattern, while other characteristics at MRI do not increase the diagnostic accuracy.
    Journal of Hepatology 02/2012; 56(6):1317-23. DOI:10.1016/j.jhep.2012.01.004 · 11.34 Impact Factor
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    ABSTRACT: Conventional pathological analysis fails to achieve sufficient sensitivity and specificity for the diagnosis of hepatocellular carcinoma (HCC) in small nodules. Immunohistochemical staining for glypican 3 (GPC3), heat shock protein 70 (HSP70) and glutamine synthetase (GS) has been suggested to allow a confident diagnosis but no prospective study has established the diagnostic accuracy of this approach. The aim of this study is to assess prospectively the diagnostic accuracy of a panel of markers (GPC3, HSP70, GS) for the diagnosis of HCC in patients with cirrhosis with a small (5-20 mm) nodule detected by ultrasound screening. Sixty patients with cirrhosis with a single nodule 5-20 mm newly detected by ultrasound were included in the study. Contrast-enhanced ultrasound, magnetic resonance and fine needle biopsy of the nodule (gold standard) were performed; the biopsy was repeated in case of diagnostic failures. Three consecutive sections of the first biopsy sample with meaningful material were stained with antibodies against GPC3, HSP70 and GS. Forty patients were diagnosed with HCC. The sensitivity and specificity for HCC diagnosis were: GPC3 57.5% and 95%, HSP70 57.5% and 85%, GS 50% and 90%, respectively. The sensitivity and specificity of the different combinations were: GPC3+HSP70 40% and 100%; GPC3+GS 35% and 100%; HSP70+GS 35% and 100%; GPC3+HSP70+GS 25% and 100%. When at least two of the markers were positive (regardless of which), the sensitivity and specificity were 60% and 100%, respectively. Conventional pathological analysis yielded three false negative results, but the addition of this panel only correctly classified one of these cases as HCC. These data within a prospective study establish the clinical usefulness of this panel of markers for the diagnosis of early HCC. However, the panel only slightly increases the diagnostic accuracy in an expert setting.
    Gut 01/2012; 61(10):1481-7. DOI:10.1136/gutjnl-2011-301862 · 14.66 Impact Factor
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    Hepatology 12/2011; 54(6):2238-44. DOI:10.1002/hep.24670 · 11.06 Impact Factor
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    ABSTRACT: A 70-year-old man with operated colorectal cancer relapsed with a solitary lung metastasis. Dual time-point PET/CT performed at 60' (standard images) and after 2 hours (delayed images) showed focal uptake in the lung nodule. A second uptake in the liver dome was also visualized only in the delayed images. Radiofrequency of the lung metastasis was performed by CT-fluoroscopy guide. A PET/CT 1 month after radiofrequency showed significant reduction of activity in the delayed images, and the uptake at 3 months was virtually normal. A fine-needle biopsy of the liver lesion confirmed the final diagnosis of metastasis from adenocarcinoma.
    Clinical nuclear medicine 07/2011; 36(7):603-5. DOI:10.1097/RLU.0b013e318217741b · 3.93 Impact Factor

  • Journal of Hepatology 03/2011; 54. DOI:10.1016/S0168-8278(11)60969-0 · 11.34 Impact Factor

  • Journal of Hepatology 03/2011; 54. DOI:10.1016/S0168-8278(11)61018-0 · 11.34 Impact Factor
  • R Vilana · A Forner · A García · C Ayuso · C Bru ·
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    ABSTRACT: This addendum is aimed to review and discuss the updated non-invasive diagnostic algorithm recently published by the American Association for the Study of Liver Diseases (AASLD).
    Radiología 03/2011; 53(2):156-8. DOI:10.1016/j.rx.2010.10.005
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    R Vilana · A Forner · A García · C Ayuso · C Bru ·
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    ABSTRACT: Hepatocellular carcinoma is a tumor with a high incidence and high mortality. These data justify screening programs to enable curative treatments to improve survival rates. Screening the population at risk (mainly patients with cirrhosis of the liver) should include ultrasonographic examination twice yearly. Given the vascular characteristics of hepatocellular carcinoma, it can be detected using dynamic techniques (contrast-enhanced ultrasonography, CT, and MRI). In cases in which the enhancement pattern is not characteristic, these techniques should be complemented with lesion biopsy. Once hepatocellular carcinoma is diagnosed, the tumor is staged, and together with the clinical condition of the patient, the stage will determine the most appropriate treatment strategy in each case.
    Radiología 09/2010; 52(5):385-98. DOI:10.1016/j.rx.2010.05.003
  • M.I. Real · L Bianchi · R Vilana · M Burrel · J Rimola ·
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    ABSTRACT: Most patients with hepatocellular carcinoma (CHC) are not candidates for surgical resection or liver transplantation because of their stage at the time of diagnosis. There are a series of locoregional treatments that achieve a high objective response rate in this group of patients. Percutaneous ablation is considered the best treatment option for CHC (BCLC stage 0/A) not amenable to surgical treatment. In multifocal hepatocellular carcinoma without vascular invasion or extrahepatic extension (BCLC stage B), the only treatment option that has been shown to improve survival in randomized controlled trials is chemoembolization. The evaluation of the effectiveness of these treatments is based on the reduction of viable tumor observed at CT, MRI, or contrast-enhanced US. In this article, we review the indications, technique, and therapeutic efficacy of the different locoregional treatments for CHC.
    Radiología 09/2010; 52(5):399-413. DOI:10.1016/j.rx.2010.05.002
  • Article: Reply:
    Alejandro Forner · Ramón Vilana · Jordi Bruix ·

    Hepatology 08/2010; DOI:10.1002/hep.23884 · 11.06 Impact Factor
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    ABSTRACT: The aim of this study was to describe the imaging features by contrast-enhanced ultrasound (CEUS) of intrahepatic cholangiocarcinoma (ICC) in cirrhosis patients. We registered the CEUS images of cirrhosis patients with histologically confirmed ICC. In all cases magnetic resonance imaging (MRI) was done to confirm the diagnosis and/or staging purposes. A total of 21 patients met all the criteria to be included in the study. The median nodule size was 32 mm. All nodules showed contrast enhancement at arterial phase; in 10 cases it was homogeneous and in 11 cases peripheral (rim-like). All nodules displayed washout during the venous phases; it appeared during the first 60 seconds in 10 nodules, between 60-120 seconds in five cases, and in six cases after 2 minutes. Ten nodules (five larger than 2 cm) displayed homogeneous contrast uptake followed by washout and they correspond to the specific pattern of hepatocellular carcinoma according to the American Association for the Study of Liver Diseases criteria. However, none of these lesions displayed washout on MRI. CONCLUSION: CEUS should not be used as the sole imaging technique for conclusive hepatocellular carcinoma diagnosis and if the MRI does not display the diagnostic vascular pattern, a confirmatory biopsy is mandatory.
    Hepatology 06/2010; 51(6):2020-9. DOI:10.1002/hep.23600 · 11.06 Impact Factor
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    ABSTRACT: This study assesses the magnetic resonance (MR) features of intrahepatic cholangiocarcinoma (ICC) in patients with cirrhosis with specific analysis of the contrast enhancement pattern. Cholangiocarcinoma may show increased contrast uptake in the arterial phase, and, if washout in the delayed venous phase were to be detected, the noninvasive diagnostic criteria proposed in the American Association for the Study of Liver Diseases guidelines would be refuted. We reviewed the MR findings of 25 patients with cirrhosis with 31 histologically confirmed ICC nodules. Signal intensity on basal T1-weighted and T2-weighted images and characteristics of enhancement after contrast administration on arterial, portal, and delayed phase were registered. Enhancement pattern was defined according to the behavior of the lesions in each phase, and dynamic pattern was described according to the progression of enhancement throughout the different phases. The most frequent pattern displayed by ICC was a progressive contrast uptake (80.6%). Stable contrast enhancement was registered in 19.4%. None of the ICCs showed a washout pattern, a profile that is specific for hepatocellular carcinoma (HCC). The ICC dynamic behavior differed significantly according to tumor size: progressive enhancement pattern was the most frequent (20 of 25 cases) in lesions larger than 20 mm, whereas the stable pattern was mainly identified in nodules smaller than 20 mm. The most characteristic MR contrast pattern in ICC in cirrhosis is a progressive contrast uptake throughout the different phases, whereas contrast washout at delayed phases is not observed. Because stable enhancement pattern without washout also can be registered in small HCC nodules, the evaluation of delayed phase is mandatory for a proper nodule characterization. If washout is not registered, a biopsy should be mandatory for diagnosis.
    Hepatology 09/2009; 50(3):791-8. DOI:10.1002/hep.23071 · 11.06 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the prognostic value of 10-MHz sonography in measuring melanoma thickness before biopsy or excision. Fifty-four patients with lesions suggestive of melanoma participated in the study. Lesions were measured on sonography using a 10-MHz linear transducer before routine biopsy and histopathologic analysis. Sonographic measurements were compared with histopathologic results (Breslow index) using Pearson's correlation coefficient and concordance analysis. Additional statistical analyses included sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 10-MHz sonography in identifying lesions > 1 mm thick. Histopathologic analysis identified all 54 lesions as melanoma. On sonography, 34 lesions measured < or = 1 mm and 20 lesions, > 1 mm. Histopathologic analysis showed 32 lesions with a Breslow index of < or = 1 mm and 22 lesions with a Breslow index of > 1 mm. The median thickness of the 54 lesions was 1.33 mm (range, 0-5 mm) by the Breslow index compared with 1.85 mm (range, 0-4.8 mm) by sonography. Comparison of sonographic measurements and Breslow index values gave a correlation coefficient of 0.93 and a concordance coefficient of 0.99. Overall, sonographic measurements showed 86% sensitivity, 97% specificity, 93% accuracy, 95% positive predictive value, and 91% negative predictive value in identifying lesions with a Breslow index of > 1 mm. In our series of 54 melanomas, 10-MHz sonography measured lesion thickness with good accuracy compared with histopathology. Sonography was effective in discriminating between tumors < or = 1 mm thick and those > 1 mm thick.
    American Journal of Roentgenology 09/2009; 193(3):639-43. DOI:10.2214/AJR.08.1387 · 2.73 Impact Factor
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    ABSTRACT: The study evaluates the outcome of patients who performed orthotopic liver transplantation (LT) as treatment for hepatocellular carcinoma (HCC), with percutaneous ethanol injection (PEI) while on the waiting list, verifying the effectiveness of this treatment in producing tumor necrosis and avoiding dropout and identifying treatment-related complications. Medical records of 97 patients on the waiting list for LT at Hospital Clinic of Barcelona were examined. Sixty-two (56.3%) patients had been treated with PEI (group 1); 35 (31.8%) had not received any anti-tumor therapy before LT (group 2). Complete necrosis of the tumor was observed in 38/59 (64.3%) patients. The presence of additional nodules in the explant and the diameter of the main tumor of group 1 was significantly lower than in group 2 (p = 0.002). Dropout related to tumor progression occurred in 4.8% and 8.5%, and tumor recurrence in 5% and 6.2% for groups 1 and 2, respectively. Major complications were not evidenced after 421 PEI sessions and there was no tumor implant in the needle traject. In conclusion, the percutaneous treatment of HCC with PEI is a safe and effective method before the LT.
    Annals of hepatology: official journal of the Mexican Association of Hepatology 07/2009; 8(3):220-7. · 2.07 Impact Factor

Publication Stats

5k Citations
538.21 Total Impact Points


  • 1992-2015
    • University of Barcelona
      • Department of Medicine
      Barcino, Catalonia, Spain
  • 1989-2014
    • Hospital Clínic de Barcelona
      • • Servicio de Hepatología
      • • Servicio de Radiodiagnóstico
      Barcino, Catalonia, Spain
  • 2001-2012
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
    • Consorci MAR Parc de Salut de Barcelona
      Barcino, Catalonia, Spain
  • 2011
    • University of Bologna
      Bolonia, Emilia-Romagna, Italy
    • RWTH Aachen University
      • Department of Surgery
      Aachen, North Rhine-Westphalia, Germany
  • 2004
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain