Tract ablation after radiofrequency ablation to prevent viable tumor cell adhesion to the needle electrode.

PURPOSE: To evaluate whether the additive needle tract ablation (TA) can reduce adherent cells on the needle tract after radiofrequency ablation (RFA) in a preclinical HCC mouse model. METHODS: Hep3B-Luc cells were engrafted in the Balb/c-nude mice. Nineteen mice were randomly assigned into three groups: the needle only group (needle placement only without performing RFA), the RFA only group (needle placement with active RFA treatment), and the RFA-TA group (needle placement with active RFA treatment and additive tract ablation). The 17-gauge needle with a 10-mm active tip was used. After RFA and TA, the viability of adherent tumor cells on the RFA needle was evaluated with bioluminescence imaging (BLI) and live-cell counting. RESULTS: We observed that RFA-TA group had the lowest BLI values compared with other groups (needle only group, 11.2 ± 6.4 million; RFA only group, 13.6 ± 9.1 million; RFA-TA group, 1.11 ± 0.8 million, p = 0.001). Live cell counting with acridine orange/propidium iodide staining also confirmed that the counted viable cell numbers in RFA-TA group were lowest compared to the other groups (needle only group, 14.8 ± 4.5; RFA only group, 643.8 ± 131.9; RFA-TA group, 1.5 ± 0.9, p < 0.001). CONCLUSIONS: The additive tract ablation can significantly reduce the number of viable tumor cells adherent to the RFA needle, which can prevent needle tract seeding after RFA procedure.

Whole tumor ablation of locally recurred hepatocellular carcinoma including retained iodized oil after transarterial chemoembolization improves progression-free survival.

OBJECTIVES: To evaluate and compare clinical outcomes of two different radiofrequency ablation (RFA) methods for locally recurred hepatocellular carcinoma (LrHCC) after locoregional treatment. METHODS: Our institutional review board approved this study with a waiver of informed consent. A total of 313 patients previously treated with transarterial chemoembolization (TACE) (n = 167) and RFA (n = 146) with a single LrHCC ≤ 3 cm was included from five tertiary referral hospitals. RFA was done for LrHCCs using either viable tumor alone ablation (VTA) method (VTA: n = 61 in the TACE group and n = 127 in the RFA group) or whole tumor ablation (WTA) method which includes both viable tumor and retained iodized oil or previously ablated zone (WTA: n = 106 in the TACE group and n = 19 in the RFA group). Local tumor progression (LTP)-free survival as well as progression-free survival (PFS) were estimated using the Kaplan-Meier method, and prognostic factors were evaluated using the Cox proportional hazards regression model. RESULTS: In 167 patients with LrHCC who underwent TACE, the 5-year LTP-free survival after RFA was significantly higher with the VTA method than with the WTA method (26.9% vs. 87.8%; p < 0.001; hazard ratio (HR) = 8.53 [4.16-17.5]). The estimated 5-year PFS after RFA for LrHCC after TACE using the VTA method was 5.7%, which was significantly lower than that with the WTA method (26.4%) (p = 0.014; HR = 1.62 [1.10-2.38]). However, in 146 patients with LrHCC after initial RFA, there were no significant differences in cumulative incidence of LTP (p = 0.514) or PFS (p = 0.905) after RFA between the two ablation methods. CONCLUSIONS: For RFA of LrHCC after TACE, the WTA method including both viable tumor and retained iodized oil could significantly lower LTP and improve PFS than VTA. KEY POINTS: • Whole tumor ablation (WTA) could provide significantly better local tumor control for locally recurred HCC (LrHCC) after TACE than viable tumor alone ablation (VTA). • WTA for LrHCC after TACE could also provide significantly better progression-free survival than VTA. • Regarding LrHCC after RFA, VTA would provide a comparable clinical outcome to WTA.

Locally advanced rectal cancer: post-chemoradiotherapy ADC histogram analysis for predicting a complete response.

BACKGROUND: The value of diffusion-weighted imaging (DWI) for reliable differentiation between pathologic complete response (pCR) and residual tumor is still unclear. Recently, a few studies reported that histogram analysis can be helpful to monitor the therapeutic response in various cancer research. PURPOSE: To investigate whether post-chemoradiotherapy (CRT) apparent diffusion coefficient (ADC) histogram analysis can be helpful to predict a pCR in locally advanced rectal cancer (LARC). MATERIAL AND METHODS: Fifty patients who underwent preoperative CRT followed by surgery were enrolled in this retrospective study, non-pCR (n = 41) and pCR (n = 9), respectively. ADC histogram analysis encompassing the whole tumor was performed on two post-CRT ADC600 and ADC1000 (b factors 0, 600 vs. 0, 1000 s/mm(2)) maps. Mean, minimum, maximum, SD, mode, 10th, 25th, 50th, 75th, 90th percentile ADCs, skewness, and kurtosis were derived. Diagnostic performance for predicting pCR was evaluated and compared. RESULTS: On both maps, 10th and 25th ADCs showed better diagnostic performance than that using mean ADC. Tenth percentile ADCs revealed the best diagnostic performance on both ADC600 (AZ 0.841, sensitivity 100%, specificity 70.7%) and ADC1000 (AZ 0.821, sensitivity 77.8%, specificity 87.8%) maps. In comparison between 10th percentile and mean ADC, the specificity was significantly improved on both ADC600 (70.7% vs. 53.7%; P = 0.031) and ADC1000 (87.8% vs. 73.2%; P = 0.039) maps. CONCLUSION: Post-CRT ADC histogram analysis is helpful for predicting pCR in LARC, especially, in improving the specificity, compared with mean ADC.

Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: gadoxetic acid--enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation.

PURPOSE: To retrospectively evaluate findings of chemotherapy-induced focal hepatopathy (CIFH) on gadoxetic acid-enhanced magnetic resonance (MR) and diffusion-weighted (DW) images and to determine imaging features that are most helpful in differentiating CIFH from metastasis. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and informed consent was waived. MR images, including DW images and gadoxetic acid-enhanced images, from 12 patients (four men, eight women; age range, 25-64 years) with 15 CIFHs were reviewed independently and in consensus by two radiologists and were compared with those obtained in 20 control patients (12 men, eight women; age range, 32-84 years) with 30 hepatic metastasis who were matched for tumor size, primary organ, and chemotherapy regimen. Interobserver agreement was assessed with κ statistics, and univariate analysis was performed for comparisons. For quantitative analyses, apparent diffusion coefficients (ADCs) and lesion-to-liver contrast ratios (CRs) were measured. Histopathologic examinations were performed for CIFHs. RESULTS: Histopathologic examination revealed that the development of CIFHs was attributable to accentuated manifestations of sinusoidal obstruction syndrome. Interobserver agreement was excellent (κ > 0.85). An ill-defined margin on hepatobiliary phase (HBP) images was the most discriminating independent variable in the differentiation of CIFH from metastasis (odds ratio, 16; P = .009). ADC and CR values in CIFH group were significantly higher than those in metastasis group (P < .001 and P = .041). CONCLUSION: CIFH should be considered a mimicker of metastasis in patients with gastrointestinal malignancy during chemotherapy. CIFH can be differentiated from metastasis on the basis of gadoxetic acid-enhanced MR and DW imaging findings; an ill-defined margin on HBP images was especially characteristic.

Gastrointestinal bleeding in adult patients with Henoch-Schönlein purpura.

We investigated the clinical and endoscopic features of gastrointestinal lesions in adults with Henoch-Schönlein purpura (HSP) causing gastrointestinal bleeding. The study included 24 adult HSP patients with gastrointestinal hemorrhage who underwent both upper gastrointestinal endoscopy and colonoscopy. The controls were 27 adult HSP patients without gastrointestinal hemorrhage. Patients with gastrointestinal bleeding showed higher frequencies of purpura on the upper extremities and trunk, and of elevated serum C-reactive protein (CRP). The rate of concurrent lesions in both the upper and lower gastrointestinal tracts was 91.7 %. The second portion of duodenum and terminal ileum were most frequently and severely involved. Leukocytoclastic vasculitis was detected in severe lesions and was significantly associated with mucosal ischemic changes. Most lesions (95.7 %) dramatically improved after corticosteroid therapy. This study suggests that both upper and lower gastrointestinal examinations are necessary for proper evaluation of gastrointestinal bleeding in patients with HSP.

Accuracy of preoperative MRI in predicting pathology stage in rectal cancers: node-for-node matched histopathology validation of MRI features.

BACKGROUND: Few studies that meticulously match individual lymph nodes seen on MRI with their precise histologic counterparts after total mesorectal excision have been reported. OBJECTIVE: The objective of this study was to determine whether preoperative MRI could detect lymph node metastases accurately in the node-by-node analysis. DESIGN: This was a prospective, observational cohort study. SETTINGS: The study was conducted at a tertiary-care hospital. PATIENTS: Forty patients with rectal cancer were enrolled. MAIN OUTCOME MEASURES: Specimens were assessed using MRI for clinical staging. After surgical resection of the tumor, the specimens were again imaged with ex vivo ultrasound scan to localize the perirectal node. The locations of each lymph node were precisely matched with its corresponding magnetic resonance image to enable a node-for-node comparison of magnetic resonance images and histologic findings. RESULTS: Agreement between MRI and histologic assessment of T stage was 82.5%. Of the 341 nodes harvested, 120 were too small (<3 mm) to be depicted on magnetic resonance images, and 18 of these contained metastasis (15%). A correlation between the results of MRI and histopathology was feasible for 205 lymph nodes, and the overall success rate of matching between the 2 techniques was 91.1% (205 of 221). Preoperative MRI revealed a node-by-node sensitivity and positive predictive value of 58.0%, and 61.7%. There was no difference in the diagnostic accuracy between the primary surgery subgroup and preoperative radiation subgroups. LIMITATIONS: The study is limited by its heterogeneity of cohorts including the subgroup with preoperative chemoradiation and the lack of preoperative ultrasound assessment. CONCLUSIONS: Preoperative MRI was moderately accurate for the prediction of mesorectal lymph node metastasis. Moreover, preoperative MRI was insufficient for detecting small lymph nodes (<3 mm) with metastasis.

Prognostic stratification by extramural depth of tumor invasion of primary rectal cancer based on the Radiological Society of North America proposal.

OBJECTIVE: The purpose of this study was to investigate the diagnostic performance of MRI in stratifying tumors stage III (T3) in patients with rectal cancer by measuring the extramural depth of tumor invasion based on the Radiologic Society of North America (RSNA) proposal and to validate its role as a prognostic indicator. MATERIALS AND METHODS: From January 2006 to July 2009, 146 patients with surgically and pathologically confirmed T3 rectal adenocarcinoma who underwent preoperative MRI were enrolled. Two blinded radiologists measured the maximum extramural depth of tumor invasion on T2-weighted images. To evaluate the diagnostic performance of MRI for stratifying subgroups, the study population was assigned into three subgroups (T3a, T3b, and T3c) according to extramural depth of tumor invasion (< 5, 5-10, and > 10 mm).To validate the role of extramural depth of tumor invasion as a prognostic indicator, Cox regression analysis was used for estimation of independent risk factors for postoperative recurrence. Three-year recurrence-free survival was evaluated by the Kaplan-Meier method with a log-rank test. Histopathologic reports were used as the reference standard. RESULTS: The overall accuracy of MRI for stratifying subgroups was 71.2% (104/146) and 77.4% (113/146) for reviewers 1 and 2. Extramural depth of tumor invasion was an independent risk factor for 3-year recurrence-free survival (hazard ratio, 2.186; 95% CI, 1.336-3.577; p = 0.002). Kaplan-Meier curves revealed a significant difference in 3-year recurrence-free survival rates for each subgroup (86%, 69%, and 43% for T3a, T3b, and T3c; p < 0.03). CONCLUSION: MRI can be used for prognostic stratification according to extramural depth of tumor invasion based on the RSNA proposal for patients with T3 rectal cancer.

Iatrogenic pancreatitis in patients with IPMN after ERCP: incidence and predictive signs.

BACKGROUND AND AIMS: The prevalence of intraductal papillary mucinous neoplasm (IPMN) has recently increased, and endoscopic retrograde cholangiopancreatography (ERCP) is a major diagnostic modality for IPMN. The aim of our study was to determine the prevalence rate of iatrogenic pancreatitis in the patients with IPMN and the predictive signs on pre-procedural images and endoscopic procedures. PATIENTS AND METHODS: At a single center, patients who underwent ERCP between September 2001 and December 2010 were included in this study. The presence of iatrogenic pancreatitis was evaluated and the difference of prevalence in the patients with/without IPMN was determined. Then, a review of cross-sectional images was performed. RESULTS: The prevalence rate of iatrogenic pancreatitis in the patients with IPMN was 20% and that in the patients with other pancreatic cystic lesions was 14%. Mural nodules on images and filling defects on ERCP were more highly detected in the patients without iatrogenic pancreatitis (p = 0.040 and p = 0.027, respectively). In the multivariate analysis, the presence of filling defects correlated with a decreased incidence of iatrogenic pancreatitis (odds ratio = 0.119 and p = 0.047). CONCLUSION: In this study, the prevalence rate of ERCP-induced pancreatitis in the patients with IPMN was 21%, and the presence of filling defects was associated with a decreased incidence of iatrogenic pancreatitis.

Peritoneal manifestations of fascioliasis on CT images: a new observation.

PURPOSE: To describe peritoneal manifestations of fascioliasis on CT. MATERIALS AND METHODS: We reviewed CT images in 31 patients with fascioliasis confirmed by enzyme-linked immunosorbent assay (ELISA) (n = 24) or surgery (n = 7). Image analyses were performed to identify hepatic, biliary, and peritoneal abnormalities. RESULTS: Hepatic abnormalities were seen in 28 (90.3 %) of the 31 patients. The most common finding was caves sign, which was present in 25 (80.1 %) patients. Three patients (9.7 %) presented with biliary abnormalities exhibiting dilatation and enhancing wall thickening of the bile duct, wall thickening of the gallbladder, and elongated structures in the bile duct or gallbladder. Peritoneal abnormalities were seen in 14 (45.2 %) of the 31 patients. The most common peritoneal abnormality was mesenteric or omental infiltration, which was seen in 9 (29.0 %) patients. Other peritoneal findings included lymph node enlargement (n = 7), ascites (n = 7), thickening of ligamentum teres (n = 2), and peritoneal mass (n = 2). CONCLUSION: Peritoneal manifestations of fascioliasis are relatively common, and CT findings include mesenteric or omental infiltration, lymph node enlargement, ascites, thickening of the ligamentum teres, and peritoneal masses.

Noninvasive assessment of hepatic fibrosis using gadoxetate-disodium-enhanced 3T MRI.

INTRODUCTION: Gadoxetate-disodium is a liver-specific MR contrast agent absorbed by hepatocytes via organic anion transporting polypeptide 1B3 and is excreted into the biliary system by multidrug resistance-associated protein 2. It has been suggested that relative parenchymal enhancement on hepatocyte phase image is associated with hepatic function. However, it is not clear whether gadoxetate-disodium-enhanced MRI can be used as a noninvasive fibrosis marker. Thus, the purpose of our study was to evaluate the diagnostic performance of gadoxetate-disodium-enhanced MRI in predicting the hepatic fibrosis stage. MATERIALS AND METHODS: A total of 113 patients who had fibrosis staged according to the Batts and Ludwig score were enrolled: F0 (n = 13), F1 (n = 18), F2 (n = 15), F3 (n = 32), and F4 (n = 35). All patients underwent gadoxetate-disodium-enhanced MRI before confirmation by biopsy (n = 67) or surgery (n = 46). For quantitative analysis, the contrast enhancement index (CEI) was calculated by measuring the signal intensity (SI) in liver and paraspinal muscle using a region of interest, as follows: CEI = (liver SI/paraspinal muscle SI) 20 min hepatocyte phase image/(liver SI/paraspinal muscle SI) pre-contrast T1-weighted image. The diagnostic performance was evaluated by the ROC curve, adjusted for the prevalence of each fibrosis stage. RESULTS: A significant negative correlation was observed between CEI and fibrosis stage (r = -0.545, P < 0.0001). The adjusted AUROC for CEI in the prediction of mild (≥F1), moderate (≥ F2), or severe fibrosis (≥ F3) and liver cirrhosis (F4) was 0.668, 0.703, 0.73, and 0.84, respectively. IN CONCLUSION: our results demonstrate that quantitative analysis of relative hepatic enhancement using gadoxetate-disodium-enhanced MRI can predict the hepatic fibrosis stage.

Pilot study of adjuvant chemotherapy with 3-week combination of S-1 and cisplatin for patients with stage II-IV (M0) gastric cancer.

PURPOSE: The feasibility of a 3-week combination of S-1 and cisplatin as an adjuvant chemotherapy for patients with curatively resected gastric cancer was investigated. EXPERIMENTAL DESIGN: Korean patients with stage II-IV (M0) gastric adenocarcinoma who underwent a gastrectomy with D2 lymph node resection were enrolled. The S-1 was administered orally at 80 mg/m(2) divided into two daily doses for 14 days, while the cisplatin was administered at 60 mg/m(2) intravenously over 2 h every 21 days. The patients received a maximum of six cycles. RESULTS: From January 2006 to July 2010, 74 patients were included in this study. The median patient age was 56 years (range, 22-71), and 51.4% (38/74) of the patients had a performance status of 0. The median number of chemotherapy cycles administered was 6 (range, 1-6). The median relative dose intensity was 86.4% for S-1 and 80.0% for cisplatin. With a median follow-up duration of 13.9 months, the median relapse-free survival (RFS) and overall survival (OS) have not yet been reached. Fifteen relapses (20.3%) were documented. Plus, the estimated RFS rate was 60.5% at 3 years. The treatments were generally well tolerated. The most frequently observed grade 3-4 hematological toxicity was neutropenia (35.1%), and only 1 cycle of neutropenic fever occurred. The most frequently observed grade 3-4 non-hematological toxicities were nausea (4.1%) and asthenia (4.1%), and all the other grade 3-4 non-hematological toxicities were observed in less than 3% of the patients. CONCLUSIONS: Postoperative adjuvant S-1 plus cisplatin for 18 weeks was found to be feasible for patients with stage II-IV (M0) gastric adenocarcinoma following complete surgical resection.

Variation in hepatic segmental volume distribution according to different causes of liver cirrhosis: CT volumetric evaluation.

OBJECTIVE: To investigate if there is difference in hepatic segmental volume distribution according to causes of liver cirrhosis (LC) using computed tomography volumetric analysis. METHODS: On computed tomographic scans, hepatic segmental volumes were measured in 90 patients with LC of 4 different causes (alcohol, hepatitis B virus (HBV), hepatitis C virus (HCV), and cryptogenic cirrhosis). The volumetric indices were compared. RESULTS: The volume proportion of the lateral segment in the liver in patients with HBV was significantly higher than in the patients with HCV (P = 0.038). Hepatic volume distribution in alcoholic LC showed differences: larger caudate lobe volume than HBV- and HCV-induced LC (P = 0.029 and P = 0.031), larger right lobe volume (P = 0.043) and smaller proportion of the lateral segment in the liver (P = 0.003) than in HBV-induced LC. CONCLUSIONS: Computed tomography volumetric analysis showed differences in hepatic segmental volume distribution in cirrhotic patients according to causes of LC.

Efficacy of US-guided percutaneous cholecystocholangiography for the early exclusion and type determination of biliary atresia.

PURPOSE: To evaluate the efficacy of ultrasonographically (US)-guided percutaneous cholecystocholangiography (PCC) for early diagnosis and characterization of biliary atresia in infants with cholestatic liver disease. MATERIALS AND METHODS: Institutional review board approval was obtained for this study. Parental informed written consent was obtained. From October 2003 to August 2010, 22 infants (12 male, 10 female; age range, 1-138 days) were referred to the radiology department for PCC. Indications for PCC were suspected biliary atresia at 24-hour delayed technetium 99m-diisopropyl-phenylcarbamoylmethyl-iminodiacetic acid (DISIDA) scintigraphy because no excretion was observed in the small bowel (n = 17) or when the results of the scan or liver biopsy could not be obtained within 3 days because of a delay in schedule (n = 5). A diagnosis of biliary atresia was excluded when there was contrast material visualized in the gallbladder, biliary system, and passage to the duodenum. Patients with biliary atresia underwent surgery as the reference standard. RESULTS: Among the 18 patients who underwent successful PCC, biliary atresia was excluded in 13, with diagnoses as follows: total parenteral nutrition-associated cholestasis (TPNAC) (n = 6), neonatal hepatitis (n = 4), congenital syphilis (n = 1), neonatal lupus (n = 1), and congenital cytomegalovirus hepatitis (n = 1). Biliary atresia was diagnosed in five patients (four with type IIIb and one with type IIIa) and was confirmed at surgery. In four infants in whom US-guided gallbladder puncture had failed, biliary atresia (n = 2) and TPNAC (n = 2) were diagnosed. CONCLUSION: PCC is a safe and useful technique for early exclusion when biliary atresia cannot be ruled out after traditional screening tests; in addition, it may be useful for preoperative type determination of biliary atresia. © RSNA, 2011.

Percutaneous embolization of persistent biliary and enteric fistulas with Histoacryl.

PURPOSE: To describe our experience with transcatheter n-butyl-2-cyanoacrylate (NBCA) embolization of refractory enteric or biliary fistulas. MATERIALS AND METHODS: Between March and December 2009, a retrospective analysis of patients with enteric or biliary fistulas revealed 11 cases unresponsive to drainage and treatment with NBCA (seven men; age range, 36-81 y). Fistula output ranged from 100 to 300 mL per day. Embolization was performed 20-55 days (mean, 32 d) after a fistula was noted on a radiograph of the abscess performed through a previously placed percutaneous drainage catheter. Digital subtraction imaging of the abscess via the percutaneous drainage catheter was used to show enteric or biliary communications and fistula tract. After the fistula tract was identified, it was cannulated under fluoroscopic guidance with a guide wire and a 5-F angiographic catheter. In embolization procedures, NBCA was deployed to fill and seal the entire tract and remnant abscess cavity. RESULTS: In all patients, enteric or biliary fistula output ceased after one or two procedures without any complications. No recurrence was noted during follow-up of 9-17 months. CONCLUSIONS: Persistent enteric or biliary fistulas can be treated successfully by transcatheter image-guided NBCA embolization. This may decrease the morbidity associated with prolonged external drainage and avert the need for surgery.

Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation.

BACKGROUND: Most ductal carcinoma in situ (DCIS) of the breast is asymptomatic and usually manifests as calcifications in screening mammography. On the other hand, little is known about ultrasonographic (US) features of asymptomatic DCIS, for US is rarely used for the diagnosis and evaluation of DCIS because of low sensitivity in detecting microcalcifications. PURPOSE: To evaluate US detection and characterization of DCIS in asymptomatic women and correlate these imaging findings with the histopathologic features. MATERIAL AND METHODS: This retrospective study evaluated mammographic and US images of 60 DCIS cases from 59 asymptomatic women. US was performed in knowledge of mammographic findings. The following histopathologic parameters were analyzed: Van Nuys classification, architectural pattern, and presence of microinvasion. Image detectability and US features were correlated with these histopathologic parameters. RESULTS: Of the 54 cases (90.0%) detected on mammography, 48 cases (88.9%) had microcalcifications only, 5 (9.3%) had microcalcifications with associated density, and 1 (1.9%) had soft tissue density alone. Of the 38 cases (63.3%) identified by US, 29 cases (76.3%) had a mass with or without microcalcifications, six (15.8%) had microcalcifications only, and three (7.9%) had other findings. US identified lesions were associated with higher Van Nuys groups, microinvasion and comedocarcinoma (P = 0.044, P = 0.024, and P = 0.032, respectively). The most common US finding was a not-circumscribed, oval mass with parallel orientation and normal acoustic transmission. Microcalcifications were seen on US in 31 (81.6%) of the 38 US visible cases; this finding showed a trend of association with Van Nuys group 2 and 3 but was not statistically significant (P = 0.063). CONCLUSION: When DCIS was identified on US, it was associated with more aggressive histopathologic type. However, mammographic correlation is essential to differentiate benign from malignant lesion in cases seen by US; US findings of asymptomatic DCIS had a low suspicion of malignancy.

Biliary tract depiction in living potential liver donors: intraindividual comparison of MR cholangiography at 3.0 and 1.5 T.

PURPOSE: To intraindividually compare the accuracy of magnetic resonance (MR) cholangiography at 3.0 and 1.5 T for depicting biliary anatomy with intraoperative cholangiography as the reference standard and to compare the image quality for biliary tract visualization at these two field strengths. MATERIALS AND METHODS: After obtaining institutional review board approval and informed consent, 52 living potential liver donors underwent MR cholangiography at both 1.5 and 3.0 T. The protocol included projectional single-section rapid acquisition with relaxation enhancement (RARE) and respiratory-triggered three-dimensional (3D) fast spin-echo (SE) T2-weighted sequences. Two readers independently analyzed images, scoring the visualization of all first- and second-order biliary branches on a four-point scale and determining the number of visible third-order branches. RESULTS: MR cholangiography at 3.0 T correctly depicted biliary anatomy in 90.4% of subjects on combined analysis of both sequences by both readers, in 88.5% with projectional RARE images for both readers, and in 84.6% and 88.5% with 3D fast SE images for readers 1 and 2, respectively. MR cholangiography at 1.5 T showed 86.5% and 84.6% accuracy on combined analysis for readers 1 and 2, respectively; 78.8% and 75.0% accuracy on projectional RARE images for readers 1 and 2, respectively; and 84.6% and 86.5% accuracy with 3D fast SE images for readers 1 and 2, respectively. With the projectional RARE sequence, 3.0-T MR cholangiography demonstrated significantly higher mean visualization scores for second-order branches (reader 1: 2.29 vs 1.78, P = .01; reader 2: 2.52 vs 2.10, P < .01) and mean numbers of visible third-order branches (reader 1: 5.53 vs 4.21, P < .01; reader 2: 5.91 vs 3.74, P < .01) than did 1.5-T MR cholangiography. CONCLUSION: Compared with 1.5-T MR cholangiography, 3.0-T MR cholangiography did not significantly increase accuracy for identification of biliary anatomy. Projectional RARE images at 3.0 T enabled better visualization of second- and third-order branches than did those at 1.5 T.

Influence of preoperative portal hypertension and graft size on portal blood flow velocity in recipient after living donor liver transplantation with right-lobe graft.

OBJECTIVE: The purpose of this study was to determine the range of portal blood flow velocity at Doppler sonography of recipients without major complications after right-lobe living donor liver transplantation and to explore factors affecting portal blood flow velocity. MATERIALS AND METHODS: Seventy-one patients (59 men, 12 women; mean age, 48.1 +/- 8.8 [SD] years; range 19-69 years) who underwent right-lobe living donor liver transplantation were enrolled. At preoperative Doppler sonography, peak portal blood flow velocity was measured at the main portal vein. On CT scans, varix score was calculated by subcategorization and grading of varices, and splenic volume was measured. The recipient's body weight and the graft weight were measured, and the graft-to-body weight ratio was calculated. Postoperatively, peak portal blood flow velocity of the recipient portal vein was measured at Doppler sonography on the first three postoperative days. The correlations between preoperative peak portal blood flow velocity, varix score, splenic volume, recipient body weight, graft weight, graft-to-body weight ratio, and recipient portal blood flow velocity were evaluated with Pearson's and Spearman's tests. Multiple regression analysis was performed to determine the factors independently correlated with recipient portal blood flow velocity. RESULTS: The mean peak recipient portal blood flow velocity was 47 +/- 14 cm/s (range, 23-86 cm/s). Portal blood flow velocity increased significantly as varix score increased (r = 0.463, p < 0.001). Weak positive correlations were found between portal blood flow velocity and graft weight (r = 0.255, p = 0.032) and graft-to-body weight ratio (r = 0.242, p = 0.042). Multiple regression analysis showed varix score and graft-to-body weight ratio independently correlated with portal blood flow velocity (beta = 2.496, p < 0.001; beta = 19.791, p = 0.014). CONCLUSION: Depending on the severity of preoperative portal hypertension and graft size, recipient portal blood flow velocity has a wide range in the days immediately after right-lobe living donor liver transplantation.

Diagnostic value of early-phase-enhanced computed tomography for the differentiation of pulmonary metastases from hepatocellular carcinoma and primary lung cancer.

BACKGROUND: The lung is the most common site of distant metastases from hepatocellular carcinoma. Correct differentiation between metastatic hepatocellular carcinoma of the lung and primary lung cancer is sometimes difficult without biopsy. PURPOSE: To evaluate the usefulness of measuring the attenuations of pulmonary nodules on early-phase contrast-enhanced computed tomography (CT) for the differentiation of pulmonary metastases from hepatocellular carcinoma and primary lung cancer. MATERIAL AND METHODS: Thirteen patients with pulmonary metastases from hepatocellular carcinoma (nine men, four women; age 53.9+/-14.2 years, range 16-70 years) and 25 patients with primary lung cancer (14 men, 11 women; age 62.2+/-9.4 years, range 43-72 years) were retrospectively evaluated. Contrast-enhanced scans were obtained 35 s after commencing intravenous injection of contrast medium. Attenuation values and the size of the pulmonary nodules were measured on contrast-enhanced CT scans. CT and clinical features were analyzed with regard to age, sex, body surface area of the patients, the attenuation values and size of the nodules, and CT machines using univariate analysis (Fisher's exact test for binary data sets and the Mann-Whitney U test for continuous data sets). Multiple linear regression analysis was used to eliminate confounding factors. RESULTS: The mean attenuation value of metastatic pulmonary nodules from hepatocellular carcinoma (75.7+/-24.9 HU) was higher than that of primary lung cancer nodules (45.8+/-14.4 HU) (P<0.01). Other variables such as age, sex, body surface area of the patients, CT device, and nodule size were not significant variables on multiple regression analysis. When a cut-off value of 75 HU was applied, the positive predictive value for diagnosing metastatic nodules from hepatocellular carcinoma was 100%. CONCLUSION: Pending confirmation in a large study, our findings suggest that there is a difference in contrast enhancement between pulmonary metastases from hepatocellular carcinoma and primary lung cancer.

Variable CT findings of epithelial origin ovarian carcinoma according to the degree of histologic differentiation.

OBJECTIVE: We wanted to evaluate the CT findings of epithelial origin ovarian carcinoma according to the degree of histologic differentiation. MATERIALS AND METHODS: This study enrolled 124 patients with 31 well differentiated, 44 moderately differentiated and 95 poorly differentiated carcinomas with epithelial origin. The CT images were retrospectively evaluated with regard to bilateral ovarian involvement, the tumor's nature, lymphadenopathy, adjacent organ invasion, peritoneal tumor seeding, a large amount of ascites and distant metastasis. In cystic, predominantly cystic and mixed tumors, the tumor wall, septa, papillary projection and necrosis in the solid portion were assessed. RESULTS: Bilateral ovarian involvement was more common in the poorly (48%) and moderately (42%) differentiated carcinomas than in the well differentiated carcinomas (7%) (p < 0.05). The frequency of a predominantly solid or solid nature was greater in the moderately and poorly differentiated carcinomas than in the well differentiated carcinomas (p < 0.0001). In the 87 tumors with a cystic, predominantly cystic or mixed nature, septa greater than 3 mm, papillary projection and necrosis in the solid portion were more common in the poorly differentiated carcinoma (91%, 91% and 77%, respectively) than in the moderately (64%, 68% and 34%, respectively) and well differentiated carcinomas (63%, 47% and 27%, respectively) (p < 0.05). Lymphadenopathy, organ invasion, tumor seeding and a large amount of ascites were more common in the poorly differentiated carcinomas (38%, 27%, 73% and 69%, respectively) than in the moderately (13%, 10%, 48% and 45%, respectively) and well differentiated carcinomas (3%, 0%, 10% and 17%, respectively) (p < 0.05). CONCLUSION: Epithelial origin ovarian carcinoma shows different CT findings according to the degree of histologic differentiation.