This study compares the usefulness of expiratory arterial phase (EAP)-contrast-enhanced computed tomography (CT) (CECT) with that of inspiratory arterial phase (IAP)-CECT in adrenal venous sampling ...(AVS).
Sixty-four patients who underwent AVS and CECT at the authors' hospital between April 2013 and June 2019 were included in this study. The patients were classified into the following two groups: EAP (32 patients) and IAP (32 patients) groups. The single arterial phase images were obtained at 40 seconds in the IAP group. The double arterial phase images were obtained at 40 seconds in the early arterial phase and 55 seconds in the late arterial phase in the EAP group. The authors then compared the right adrenal vein (RAV) visualization rate on the CECT, the difference between the CECT images and adrenal venograms in the localization of the RAV orifice, the cannulation time to the RAV, and the volume of contrast agent administered intraoperatively between the two groups.
The rates of the RAV visualization in the EAP group were 84.4% in the early arterial phase, 93.8% in the late arterial phase, and 100% in the combined early and late arterial phases. The rate of the RAV visualization in the IAP group was 96.9%. There was no significant difference between the two groups in terms of the rate of the RAV visualization. However, there was a small difference in the location of the RAV orifice between the CECT images and adrenal venograms in the EAP group as compared with the IAP group (P < 0.001). The median time to the RAV catheterization was significantly shorter in the EAP group (27.5 minutes) than in the IAP group (35.5 minutes;
= 0.035). The rates of the RAV visualization in the EAP group were not significant between the early arterial phase, late arterial phase, and combined early and late arterial phases (
= 0.066). However, the mean volume CT dose index in the combined early and late arterial phases was significantly higher than in the early and late arterial phases (
< 0.001).
The EAP-CECT is more useful for increasing the speed of the RAV cannulation due to the small difference in the localization of the RAV orifice compared to IAP-CECT. However, since EAP-CECT has double contrast arterial phases and increased radiation exposure compared to IAP-CECT, only the late arterial phase may be acceptable to reduce radiation exposure.
Aim
To enhance the usefulness of splenic perfusion evaluated by means of dynamic computed tomography (CT) and spleen size in assessing the degree of liver fibrosis.
Methods
We retrospectively studied ...133 patients who had undergone dynamic CT before hepatectomy. Fibrosis was histologically established in all. First we calculated splenic perfusion parameters K1 (inflow rate constant), 1/k2 (mean transit time; MTT), and K1/k2 (distribution volume; Vd), using compartment model analysis. Then we compared the stage of fibrosis with splenic perfusion and spleen size (long axis, R), using the Kruskal–Wallis test and multiple comparisons. After that, we assessed the diagnostic accuracy of the combination of splenic perfusion, spleen size, age, gender, and the presence or absence of hepatitis B and hepatitis C viral infection in detecting liver fibrosis, using stepwise regression and receiver operating characteristic analysis.
Results
Significant differences (P < 0.05) in MTT were observed in comparisons between fibrosis stages F0 and F4, between F1 and F4, and between F2 and F4. Significant differences (P < 0.05) in R were observed in comparisons between F0 and F4, and between F1 and F4. Considering the presence or absence of hepatitis B and C viral infection along with MTT and R, the areas under the receiver operating characteristic curves were 0.89 for ≥F1, 0.83 for ≥F2, 0.82 for ≥F3, and 0.82 for F4.
Conclusion
Splenic MTT and spleen size are helpful in assessing liver fibrosis.
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BFBNIB, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Aim
To verify the utility of the 2‐in‐1‐out‐compartment model analysis (CMA) of intravenous contrast‐enhanced dynamic computed tomography (IV‐CT) for evaluating hepatic arterial and portal venous ...flow using intra‐arterial contrast‐enhanced CT (IA‐CT).
Methods
We retrospectively evaluated 49 consecutive patients who underwent IV‐CT and were radiologically or histologically diagnosed as having hepatic malignant lesion (51 classical hepatocellular carcinomas HCC, 4 early HCC, 3 cholangiolocellular carcinomas, 1 mixed HCC, 3 cholangiocellular carcinomas). As a gold standard for hepatic arterial and portal blood flows, we defined the normalized enhancement in CT values on CTAP (nCTAP) and CTHA (nCTHA). The hepatic arterial (k1a) and portal venous inflow velocity (k1p) constants in hepatic lesions and surrounding liver parenchyma were obtained from the CMA of IV‐CT with various outflow velocity constant (k2) limits using the nonlinear least square method. The correlation coefficient between the normalized enhancement in IA‐CT and CMA of IV‐CT was statistically evaluated according to various k2 limits.
Results
The highest mean correlation coefficient between k1a and nCTHA (r = 0.65, P < 0.0001) was observed when k2≦0.035. The highest mean correlation coefficient between k1p and nCTAP (r = 0.69, P < 0.0001) was observed when k2≦0.045. The decrease in correlation coefficient was significant when the upper k2 limit was lower than 0.03 or higher than 0.07 compared to the best mean correlation coefficient (P < 0.05).
Conclusion
Hepatic arterial and portal venous flows can be evaluated quantitatively to some extent with appropriate outflow velocity constant limits using the CMA of IV‐CT.
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BFBNIB, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Aim
Using classification tree analysis, we evaluated the most useful magnetic resonance (MR) image type in the differentiation between early and progressed hepatocellular carcinoma (eHCC and pHCC).
...Methods
We included pathologically proven 214 HCCs (28 eHCCs and 186 pHCCs) in 144 patients. The signal intensity of HCCs was assessed on in‐phase (T1in) and opposed‐phase T1‐weighted images (T1op), ultrafast T2‐weighted images (ufT2WI), fat‐saturated T2‐weighted images (fsT2WI), diffusion‐weighted images (DWI), contrast enhanced T1‐weighted images in the arterial phase (AP), portal venous phase (PVP), and the hepatobiliary phase. Fat content and washout were also evaluated. Fisher's exact test was performed to evaluate usefulness for the differentiation. Then, we chose MR images using binary logistic regression analysis and performed classification and regression tree analysis with them. Diagnostic performances of the classification tree were evaluated using a stratified 10‐fold cross‐validation method.
Results
T1in, ufT2WI, fsT2WI, DWI, AP, PVP, fat content, and washout were all useful for the differentiation (p < 0.05), and AP and T1in were finally chosen for creating classification trees (p < 0.05). AP appeared in the first node in the tree. The area under the curve, sensitivity and specificity for eHCC, and balanced accuracy of the classification tree were 0.83 (95% CI 0.74–0.91), 0.64 (18/28, 95% CI 0.46–0.82), 0.94 (174/186, 95% CI 0.90–0.97), and 0.79 (95% CI 0.70–0.87), respectively.
Conclusions
AP is the most useful MR image type and T1in the second in the differentiation between eHCC and pHCC.
Using classification tree analysis, we aimed to evaluate the most useful of magnetic resonance (MR) image type in differentiating between early and progressed hepatocellular carcinoma. The arterial phase image is the most useful MR image type, and T1‐weighted images in phase the second.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
A 51-year-old male patient with alcoholic cirrhosis visited our hospital for a scheduled gastrostomy replacement. During the gastrostomy replacement, he suddenly experienced a massive hemorrhage from ...the fistula site. Based on enhanced computed tomography findings, we concluded that collateral blood vessels from the left gastroepiploic vein had flowed into the varices near the gastrostomy as the main origin of the bleeding. The patient received treatment with percutaneous transhepatic occlusion for the varices, which halted blood flow to the varices. This case suggests the possibility of such a complication in patients with worsening portal hypertension and the effectiveness of percutaneous transhepatic occlusion treatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
N-butyl cyanoacrylate, one of embolic materials, is usually used as a mixture with Lipiodol (N-butyl cyanoacrylate–Lipiodol mixture). N-butyl cyanoacrylate–Lipiodol–Iopamidol was developed by adding ...a nonionic iodine contrast agent (Iopamiron) to N-butyl cyanoacrylate–Lipiodol mixture. N-butyl cyanoacrylate–Lipiodol–Iopamidol has lower adhesiveness than N-butyl cyanoacrylate–Lipiodol mixture and the ability to form a single large droplet. We report the case of a 63-year-old man with a ruptured splenic artery aneurysm treated by transcatheter arterial embolization using N-butyl cyanoacrylate–Lipiodol–Iopamidol. He was referred to the emergency room because of sudden onset of upper abdominal pain. A diagnosis was established using contrast-enhanced computed tomography and angiography. Emergency transcatheter arterial embolization was performed, and the ruptured splenic artery aneurysm was successfully embolized using a combination of coil framing and N-butyl cyanoacrylate–Lipiodol–Iopamidol packing. This case demonstrates the usefulness of a combination of coil framing and N-butyl cyanoacrylate–Lipiodol–Iopamdol packing for the embolization of aneurysms.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A 13-year-old girl presented with sudden-onset colicky abdominal pain and biliary vomiting. She was diagnosed with Peutz-Jeghers syndrome 2 months previously based on mucocutaneous pigmentation and ...hamartomatous polyposis. On diagnosis of Peutz-Jeghers syndrome, in addition to colonoscopy and esophagogastroduodenoscopy, antegrade and retrograde double-balloon enteroscopies were performed, and >10 hamartomas were resected. She was scheduled for additional elective double-balloon enteroscopy for total small-bowel observation. On visiting the emergency unit, enhanced abdominal computed tomography showed jejuno-jejunal intussusception with a polyp. There were no ischemic signs in the invaginated bowel. Urgent antegrade double-balloon enteroscopy performed 5 hours after onset of acute abdominal symptoms revealed a large polyp with intussusception stalk in the jejunum, and simultaneous reduction of intussusception and endoscopic mucosal resection of the polyp were performed successfully. There were no endoscopy-related complications, and emergent laparotomy was avoided. The patient has been asymptomatic, and total gastrointestinal screening is scheduled every 2 years. This is the first case in which emergent laparotomy was avoided by urgent double-balloon enteroscopy in an adolescent with symptomatic jejuno-jejunal intussusception. Non-surgical management of small-bowel polyps in pediatric patients with Peutz-Jeghers syndrome is beneficial as laparotomy can cause bowel adhesion and increases risk of incomplete balloon-assisted enteroscopy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A 52-year-old woman with a high serum alkaline phosphatase (ALP) level underwent a liver biopsy, which showed diffuse heavy deposition of Aκ amyloid, and was diagnosed as having immunoglobulin light ...chain (AL) amyloidosis. Although she received high-dose melphalan with stem cell transplantation and achieved a hematologic complete response (CR), her ALP level began to increase one year after treatment. Further examinations revealed that she was still in a CR state with dominant bone-type ALP, and re-biopsied liver specimens demonstrated marked regression of amyliod deposition, providing important evidence that the turnover of hepatic amyloid proteins can actually occur more rapidly than previously thought.
Background To assess the degree of hepatic fat content, simple and noninvasive methods with high objectivity and reproducibility are required. Magnetic resonance imaging (MRI) is one such candidate, ...although its accuracy remains unclear. We aimed to validate an MRI method for quantifying hepatic fat content by calibrating MRI reading with a phantom and comparing MRI measurements in human subjects with estimates of liver fat content in liver biopsy specimens. Methods The MRI method was performed by a combination of MRI calibration using a phantom and double-echo chemical shift gradient-echo sequence (double-echo fast low-angle shot sequence) that has been widely used on a 1.5-T scanner. Liver fat content in patients with nonalcoholic fatty liver disease (NAFLD, n = 26) was derived from a calibration curve generated by scanning the phantom. Liver fat was also estimated by optical image analysis. The correlation between the MRI measurements and liver histology findings was examined prospectively. Results Magnetic resonance imaging measurements showed a strong correlation with liver fat content estimated from the results of light microscopic examination (correlation coefficient 0.91, P < 0.001) regardless of the degree of hepatic steatosis. Moreover, the severity of lobular inflammation or fibrosis did not influence the MRI measurements. Conclusions This MRI method is simple and noninvasive, has excellent ability to quantify hepatic fat content even in NAFLD patients with mild steatosis or advanced fibrosis, and can be performed easily without special devices.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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