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Imaging findings and transcatheter arterial chemoembolization of hepatic malignancy with right atrial embolus in 46 patients  [cached]
Hong-Yan Cheng, Xiao-Yan Wang, Guo-Li Zhao, Dong Chen
World Journal of Gastroenterology , 2008,
Abstract: AIM: To analyze the imaging findings of hepatic malignancy with right atrial (RA) embolus.METHODS: Forty-six patients with an embolus in the RA were diagnosed, including 44 patients with hepatocellular carcinoma (HCC), 1 patient with cholangiocellular carcinoma and 1 patient with hepatic carcinoma metastasis. The diagnosis was confirmed by clinical examination, serum α-fetoprotein and imaging. Seventeen patients underwent transcatheter arterial chemoembolization (TACE).RESULTS: On enhancement computer tomography (CT) or magnetic resonance (MR) imaging, a nodular filling defect in the RA could be easily found, with a slight enhancement in the arterial phase. The coronal images of CT or MR showed the extent of lesion. Lipiodol entered the embolus after TACE, hence reducing the speed of embolus growth. There was a survival benefit for patients receiving anticancer treatment.CONCLUSION: Patients with HCC, showing a filling defect of the inferior vena cava (IVC), hepatic vein (HV) and RA on images, can be diagnosed with RA embolus. Encroachment of the RA is very rare in patients with hepatic malignancies. Furthermore, a prolongation of survival time is found in those patients who underwent TACE.
A Case of Hepatic Angiomyolipoma Which Was Misdiagnosed as Hepatocellular Carcinoma in a Hepatitis B Carrier  [PDF]
Jin Yeon Hwang,Sung Wook Lee,Yang Hyun Baek,Jong Han Kim,Ha Yeon Kim,Suck Hyang Bae,Jin Han Cho,Hee Jin Kwon,Jin Sook Jeong,Young Hoon Roh,Sang Young Han
Case Reports in Hepatology , 2012, DOI: 10.1155/2012/606108
Abstract: We report a rare case of resected hepatic AML, which was misdiagnosed as hepatocellular carcinoma in a chronic hepatitis B carrier. A 45-year-old woman who was a carrier of hepatitis B virus infection presented with a hepatic tumor. Her serum alpha-fetoprotein level was normal. Ultrasonography revealed a round and well-circumscribed echogenic hepatic tumor measuring 2.5?cm in the segment VI. On contrast-enhanced computed tomography, a hypervascular tumor was observed in the arterial phase and washing-out of the contrast medium in the portal phase and delayed phase. On MR T1-weighted in-phase images, the mass showed low signal intensity, and on out-of-phase images, the mass showed signal drop and dark signal intensity. On MR T2-weighted images, the mass showed high signal intensity. The mass demonstrated high signal intensity on arterial phase after contrast injection, suggestive of hepatocellular carcinoma. The patient underwent hepatic wedge resection and histopathological diagnosis was a hepatic angiomyolipoma. 1. Introduction Angiomyolipoma (AML) typically occurs in the kidney and rarely in liver [1]. Hepatic AML is a rare, primarily benign mesenchymal tumor, composed of blood vessels, fat tissue, and smooth muscle cells [2]. Ishak reported the first hepatic AML in 1976 [3] and since then, there have been about 200 cases reported in the literature and they have been increasing with improvement in imaging modalities, including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and fine-needle aspiration biopsy (FNAB) [4]. The hepatic AML may pose a diagnostic challenge clinically, radiologically, and pathologically because of its wide variation due to the different proportions of the three cell types which make up the tumor. In particular, in a region endemic for hepatocellular carcinoma, the diagnosis of AML by imaging modality can be difficult and frequently misdiagnosed as hepatocellular carcinoma. The definitive diagnostic study remains the histological examination coupled with immunohistochemical stains. Among the components of hepatic AML, homatropine methyl bromide 45 (HMB-45) positive smooth muscle cell is the only specific and definitive criterion for diagnosis [5]. Hepatocellular carcinoma and liver hemangioma are negative for this marker. We report a case of resected hepatic AML, which was misdiagnosed as hepatocellular carcinoma in a hepatitis B carrier. 2. Case Report A 45-year-old woman, a chronic hepatitis B carrier, was admitted to our hospital for further evaluation and treatment of a liver mass that had
Surveillance of HCC Patients after Liver RFA: Role of MRI with Hepatospecific Contrast versus Three-Phase CT Scan—Experience of High Volume Oncologic Institute  [PDF]
Vincenza Granata,Mario Petrillo,Roberta Fusco,Sergio Venanzio Setola,Elisabetta de Lutio di Castelguidone,Orlando Catalano,Mauro Piccirillo,Vittorio Albino,Francesco Izzo,Antonella Petrillo
Gastroenterology Research and Practice , 2013, DOI: 10.1155/2013/469097
Abstract: Purpose. To compare the diagnostic accuracy of hepatospecific contrast-enhanced MRI versus triple-phase CT scan after radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients. Methods. Thirty-four consecutive HCC patients (42 hepatic nodules) were treated with percutaneous RFA and underwent MR and CT scans. All patients were enrolled in a research protocol that included CT with iodized contrast medium injection and MR with hepatospecific contrast medium injection. All patients were restaged within four weeks and at 3 months from ablation. The images were reviewed by four different radiologists to evaluate tumor necrosis, residual or recurrence disease, and evidence of new foci. Results. Thirty-two nodules were necrotic after treatment; 10 showed residual disease. Six new HCCs were identified. At first month followup CT has identified 34 necrotic lesions and 8 residual diseases; no new foci were recognized. At MRI instead, 32 complete necrotic lesions were identified, 10 lesions showed residual disease, and 2 new HCCs were found. At three months, CT demonstrated 33 completely necrotic lesions, 9 residual diseases, and 2 new HCCs. MR showed 31 complete necrotic lesions, 11 cases of residual disease, and 6 new HCCs. Conclusions. Hepatospecific contrast-enhanced MRI is more effective than multiphase CT in assessment of HCC treated with RFA. 1. Introduction Hepatocellular carcinoma (HCC) is one of the most common causes of cancer death worldwide [1]. Although surgical resection offers a better curative option than nonsurgical treatments, it is not an option for the majority of patients because of the presence of poor hepatic function and the typically advanced nature of the disease at presentation [2]. Effective nonsurgical treatment of HCC includes radiofrequency ablation (RFA). Several randomized controlled trials have demonstrated that RFA is able to achieve higher rates of complete tumor ablation using fewer sessions, with tumor necrosis rates of 90–95% in solitary HCC under 4?cm [3–7]. Assessing the effectiveness of RFA is critical in determining the success of treatment and in guiding future therapy. However, current imaging modalities and imaging response criteria are limited in their ability to provide clinically satisfactory information about the extent of tumor necrosis, which is essential in determining patient prognosis [8]. In 2000, have been established common parameters to define cancer response to therapy by means of the introduction of the Response Evaluation Criteria in Solid Tumors (RECIST). RECIST 1.1, published in January
Ultrasonido con contraste de masas hepáticas Contrast-enhanced ultrasonography in hepatic masses  [cached]
Hojun Yu,Korosh Khalili,Hyun-Jung Jang,Tae Kyoung Kim
Revista Argentina de Radiología , 2009,
Abstract: El ultrasonido (US) con contraste constituye una poderosa herramienta diagnóstica en la caracterización de masas hepáticas. Las modernas técnicas de ultrasonido con contraste presentan alta sensibilidad con dosis bajas de contraste, lo que juntamente con la técnica de supresión de ecos resulta en imágenes de muy alta resolución temporal y espacial, propiciando el resurgimiento de la ultrasonografía en la era de la tomografía computada (TC) y de la resonancia magnética (RM). El agente de contraste utilizado es muy seguro, sin efectos de nefrotoxicidad y apropiado para pacientes con función renal disminuida. La posibilidad de utilizar múltiples inyecciones de micro burbujas y de realizar observaciones reiteradas de patrones de vascularización de las masas hepáticas, la convierten en una herramienta diagnóstica segura y confiable en la resolución de lesiones hepáticas indeterminadas previo a la TC y RM. En este artículo describimos los principios básicos del US con contraste, consideraciones prácticas en la realización de los estudios, debilidades y fortalezas del método en comparación con la TC y RM y patrones de vascularización en las cinco masas hepáticas más comunes: hemangioma, hiperplasia nodular focal, adenoma, carcinoma hepatocelular y metástasis. Contrast-enhanced ultrasonography (CEUS) is a powerful tool in the characterization of various liver masses. Modern techniques of contrast ultrasonography are highly sensitive to minute doses of the contrast agent and with the suppression of background tissue echoes result in images with very high contrast resolution. Added to this advantage are the high temporal and spatial resolution intrinsic to sonography in general, which have resulted in a robust resurgence of sonography in this era of CT and MRI. The excellent safety profile of the contrast agent with no nephrotoxicity allows for multiple injections of microbubble in deciphering the vascular structure and enhancement patterns of masses. These benefits enable more accurate and confident diagnosis of liver lesions allowing CEUS to be a problem solving imaging modality for indeterminate hepatic lesions on previous CT or MR. In this article, we describe the basic principles of CEUS, practical issues in performing the studies, strengths and weaknesses compared to CT and MR imaging, and patterns of enhancement seen in the 5 common hepatic masses: hemangioma, focal nodular hyperplasia, hepatic adenoma, hepatocellular carcinoma, and metastasis.
Transient hepatic attenuation difference (THAD) assosicated with liver solid masses: biphasic CT and MRI findings  [cached]
? ?brahim KARAHAN,Murat BAYKARA,?erif I?IN,Abdulhakim CO?KUN
Erciyes Medical Journal , 2003,
Abstract: Purpose: Determination of transient hepatic attenuation difference assosicated with liver solid masses with biphasic CT and MRI findings.Materials and Methods: Forty patients with solid liver masses were prospectively evaluated by biphasic CT and MRI. Six patients which showed transient hepatic attenuation difference and were diagnosed histopathologically, as having two hepatocellular carcinomas, three metastases and a pseudotumour were evaluated. Transient hepatic attenuation difference was diagnosed surgically in two patients and with follow-up imaging in four patients.Results: While transient hepatic attenuation difference areas were isodense/isointense in nonenhanced CT and T2-weighted, and nonenhanced T1-weighted MR images, these areas were hyperdense/hyperintense in early phase images and became isodense/isointense in late phase images. In addition, these areas were hyperintense in fat suppressed T2-weighted MR imagesConclusion: In early phase CT and MR images, transient hepatic attenuation difference may be accompanied by solid liver masses. These areas may be distinguished from tumoural masses by being hyperdense/hyperintense in early phase and isodense/isointense in late phase CT and MR images.
CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part II): Imaging of pancreatic carcinoma nerve invasion  [cached]
Hou-Dong Zuo,Wei Tang,Xiao-Ming Zhang,Qiong-Hui Zhao
World Journal of Radiology , 2012, DOI: 10.4329/wjr.v4.i1.13
Abstract: Computed tomography (CT) and magnetic resonance imaging (MRI) are excellent modalities which have the ability to detect, depict and stage the nerve invasion associated with pancreatic carcinoma. The aim of this article is to review the CT and MR patterns of pancreatic carcinoma invading the extrapancreatic neural plexus and thus provide useful information which could help the choice of treatment methods. Pancreatic carcinoma is a common malignant neoplasm with a high mortality rate. There are many factors influencing the prognosis and treatment options for those patients suffering from pancreatic carcinoma, such as lymphatic metastasis, adjacent organs or tissue invasion, etc. Among these factors, extrapancreatic neural plexus invasion is recognized as an important factor when considering the management of the patients.
Preoperative planning for renal cell carcinoma: benefits of 64-slice CT imaging
Dighe, Manjiri;Takayama, Thomas;Bush Jr, William H.;
International braz j urol , 2007, DOI: 10.1590/S1677-55382007000300002
Abstract: surgery is the primary form of treatment in localized renal cell carcinoma. adrenal-sparing nephrectomy, laparoscopic nephrectomy and nephron-sparing partial nephrectomy are growing trends for more limited surgical resection. accurate preoperative imaging is essential for planning the surgical approach. multislice ct and mr are regarded as the most efficient modalities for imaging renal neoplasms. development of faster ct systems like 64-slice ct with improved resolution and capability to achieve isotropic reformats have significantly enhanced the role of ct in imaging of renal neoplasms.this review article describes the present state, technique and benefits of 64-slice ct scanning in preoperative planning for rcc.
Prediction of Nodal Involvement in Primary Rectal Carcinoma without Invasion to Pelvic Structures: Accuracy of Preoperative CT, MR, and DWIBS Assessments Relative to Histopathologic Findings  [PDF]
Jun Zhou, Songhua Zhan, Qiong Zhu, Hangjun Gong, Yidong Wang, Desheng Fan, Zhigang Gong, Yanwen Huang
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0092779
Abstract: Objective To investigate the accuracy of preoperative computed tomography (CT), magnetic resonance (MR) imaging and diffusion-weighted imaging with background body signal suppression (DWIBS) in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. Methods and Materials Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phased-array coil. Preoperative lymph node staging with imaging modalities (CT, MRI, and DWIBS) were compared with the final histological findings. Results The accuracy of CT, MRI, and DWIBS were 57.7%, 63.5%, and 40.4%. The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was lower than that of CT and MRI. Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI (Kappa value = 0.331 and 0.348, P<0.01) but was relatively weaker for DWIBS (Kappa value = 0.174, P<0.05). The accuracy was 57.7% and 59.6%, respectively, for CT and MRI when the lymph node border information was used as the criteria, and was 57.7% and 61.5%, respectively, for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria. Conclusion MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.
Evaluation of the Pericardium with CT and MR  [PDF]
Julianna M. Czum,Anne M. Silas,Morgan C. Althoen
ISRN Cardiology , 2014, DOI: 10.1155/2014/174908
Abstract: The pericardium plays an important role in optimizing cardiac motion and chamber pressures and serves as a barrier to pathology. In addition to pericardial anatomy and function, this review article covers a variety of pericardial conditions, with mention of potential pitfalls encountered during interpretation of diagnostic imaging. Normal and abnormal appearance of pericardium on CT and MR imaging is emphasized, including dynamic imaging correlates of pericardial pathophysiology. 1. Introduction More than just a tissue, the pericardium is an organ with specific functions and an embryologic origin distinct from the heart. Whereas the heart is derived from splanchnic mesoderm, the pericardium is derived from somatic mesoderm [1–3]. Long-recognized functions of the pericardium include anchoring the heart in the mediastinum, minimizing the friction of cardiac motion, and serving as a barrier from infection and neoplasm [4]. More recently, the pericardium has been described as an intracardiac pressure modulator, limiting acute distention of any one cardiac chamber and preserving myofibril function by preventing sarcomere overlengthening [5, 6]. As with other organs, the pericardium is subject to various disease processes, include inflammatory, infectious, fibrotic, metabolic, and neoplastic. Imaging of these processes has advanced significantly in the past decade, with the refinement of multidetector CT and high-field-strength MRI. CT and MR permit visualization of the entire pericardium by virtue of three-dimensional acquisition and multiplanar imaging, respectively, and provide better assessment of surrounding structures than the prior standard of echocardiography [7]. In addition, MR techniques allow the evaluation of pericardial function, particularly as it relates to the problem of differentiating myocardial restriction from pericardial constriction, the latter being surgically treatable [8]. 2. Anatomic Considerations As with the other serosal surfaces of the body, the pericardium has parietal and visceral layers. The parietal layer of pericardium is several times thicker than the visceral pericardium [4]. The normal combined pericardial thickness is 2?mm or less (Figures 1(a) and 1(b)). 2-3?mm is considered equivocal, whereas 4?mm thickness at any point is abnormal [9, 10]. The normal pericardial stabilizers include the great vessel reflections and several ligaments (pericardial-sternal, pericardial-vertebral, and pericardial-diaphragmatic) (Figure 1(c)) [4]. Figure 1: Normal pericardium. (a) Gated contrast-enhanced axial CT and (b) axial double
Ultrasonido con contraste de masas hepáticas
Yu,Hojun; Khalili,Korosh; Jang,Hyun-Jung; Kim,Tae Kyoung; Atri,Mostafa;
Revista argentina de radiolog?-a , 2009,
Abstract: contrast-enhanced ultrasonography (ceus) is a powerful tool in the characterization of various liver masses. modern techniques of contrast ultrasonography are highly sensitive to minute doses of the contrast agent and with the suppression of background tissue echoes result in images with very high contrast resolution. added to this advantage are the high temporal and spatial resolution intrinsic to sonography in general, which have resulted in a robust resurgence of sonography in this era of ct and mri. the excellent safety profile of the contrast agent with no nephrotoxicity allows for multiple injections of microbubble in deciphering the vascular structure and enhancement patterns of masses. these benefits enable more accurate and confident diagnosis of liver lesions allowing ceus to be a problem solving imaging modality for indeterminate hepatic lesions on previous ct or mr. in this article, we describe the basic principles of ceus, practical issues in performing the studies, strengths and weaknesses compared to ct and mr imaging, and patterns of enhancement seen in the 5 common hepatic masses: hemangioma, focal nodular hyperplasia, hepatic adenoma, hepatocellular carcinoma, and metastasis.
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