Imaging findings of primary hepatic angiosarcoma on gadoxetate disodium-enhanced liver MRI: comparison with hepatic haemangiomas of similar size.

AIM: To describe imaging characteristics of primary hepatic angiosarcoma on gadoxetate disodium-enhanced dynamic magnetic resonance imaging (MRI) and to determine features that differentiate angiosarcomas from similar-sized haemangiomas. MATERIALS AND METHODS: The study included 15 patients with hepatic angiosarcomas and 35 patients with size-matched hepatic haemangiomas who underwent gadoxetate disodium-enhanced liver MRI. The number, size, growth pattern, signal intensity (SI) characteristics, and SI changes on dynamic scans were evaluated and compared between the two entities. RESULTS: Overall, hepatic angiosarcomas significantly more often showed lesion multiplicity (86.7%), capsular retraction (40%), prominent intratumoural vessels (66.7%), vascular invasion (20%), heterogeneous SI on T2-weighted (100%) and hepatobiliary phase images (80%), and intralesional haemorrhage (60%, all p<0.05). On dynamic scans, angiosarcomas demonstrated enhancing foci of irregular or rim-like nodular/linear or bizarre (86.7%) shapes, with centrifugal or bizarre patterns of progressive enhancement (53.3%). Enhancement of angiosarcomas was less than that of the blood pool on visual grading, but the enhancement curves followed that of the aorta. Regardless of size, angiosarcomas showed heterogeneous T2 SI, intratumoural haemorrhage, and heterogeneity during the hepatobiliary phase, whereas these findings were more common in haemangiomas >6 cm in diameter. CONCLUSION: Gadoxetate disodium-enhanced dynamic liver MRI is capable of depicting vascular hallmarks of hepatic angiosarcomas. Heterogeneous SI on T2-weighted and hepatobiliary phase images, multiplicity, and an enhancement curve following that of the aorta are also distinctive features that differentiate angiosarcomas from haemangiomas.

Radiofrequency ablation as an alternative to hepatic resection for single small hepatocellular carcinomas.

BACKGROUND: This study aimed to investigate whether radiofrequency ablation (RFA) is an alternative to surgical resection for hepatocellular carcinoma (HCC) within the context of current guidelines. METHODS: This retrospective study included patients with normal portal pressure and serum bilirubin level who initially underwent liver resection or RFA for a single HCC of maximum size 3 cm. Between-group differences in cumulative rates of survival and recurrence specific for HCC were analysed in the entire cohort and in a propensity score-matched cohort. RESULTS: A total of 604 patients were enrolled, 273 in the liver resection group and 331 in the RFA group. The 5- and 10-year HCC-specific survival rates for the resection and RFA groups were 87·6 versus 82·1 per cent and 59·0 versus 61·2 per cent respectively (P = 0·214), whereas overall 5- and 10-year recurrence-free survival rates for the corresponding groups were 60·6 versus 39·4 per cent and 37·5 versus 25·1 per cent respectively (P < 0·001). In the propensity score-matched cohort (152 pairs), there were no differences in HCC-specific survival (hazard ratio (HR) 1·03 for RFA versus resection; P = 0·899), whereas recurrence-free survival again differed between the treatment groups (HR 1·75; P < 0·001). RFA was independently associated with poorer outcomes in terms of treatment-site recurrence-free survival (adjusted HR 1·66; P = 0·026), but not non-treatment-site recurrence-free survival (adjusted HR 1·15; P = 0·354). CONCLUSION: Although RFA carries a higher risk of treatment-site recurrence than hepatic resection, it provides comparable overall survival in patients with a single small HCC without portal hypertension or a raised bilirubin level.

Percutaneous radiofrequency ablation using internally cooled wet electrodes for treatment of colorectal liver metastases.

AIM: To evaluate the efficacy and safety of internally cooled wet (ICW) electrodes, which provide interstitial infusion of saline and intra-electrode cooling simultaneously, in the percutaneous radiofrequency ablation (RFA) of liver metastases from colorectal cancer. MATERIALS AND METHODS: From February 2008 to October 2010, 27 patients with 35 hepatic metastatic lesions (mean size 1.99cm; range 0.7-3.8cm) underwent RFA using ICW electrodes. Of these 35 tumours, 32 had diameters ≤3cm, and three had diameters of 3-4cm. Moreover, 18 tumours were non-subcapsular and 17 were subcapsular. RESULTS: No patients (0%) had major complications after RFA. During follow-up (median 27 months; range 4.5-36 months), 14 of the 35 treated lesions (40%) showed local tumour progression. The local tumour progression-free survival rates at 1 and 3 years were 73 and 56%, respectively. The local tumour progression-free survival period was significantly longer in patients with tumours ≤2cm than >2cm (p<0.001), but did not differ significantly between patients with non-subcapsular and subcapsular tumours (p=0.454). The overall 1 and 3 year survival rates after RFA were 100 and 77%, respectively. CONCLUSIONS: Percutaneous RFA using ICW electrodes is safe and technically feasible for the treatment of liver metastases from colorectal cancer. It provides effective local tumour control with low complication rates and reduced number of needle placements.

Stimulation of tumor growth by human soluble intercellular adhesion molecule-1.

Because serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) are elevated in cancer and sICAM-1 is angiogenic, we tested the ability of sICAM-1 to promote tumor growth. Our preliminary experiments showed that exogenous sICAM-1 significantly stimulated the growth of human tumors in vivo. Human fibrosarcoma transfectants, which express ICAM-1, produce ICAM-1 on the cell surface and release sICAM-1 into the medium without any apparent effect on cell growth in vitro. We found that conditioned medium from sense ICAM-1 transfectants compared with mock or antisense ICAM-1 transfectants stimulates endothelial cell migration in vitro and neovascularization in the chick chorioallantoic membrane assay. Tumor cells transfected with sense constructs form faster growing tumors than mock- and antisense-transfected cells in both chick embryos and nude mice models. Serum levels of human sICAM-1 from nude mice bearing sense ICAM-1 transfectants correlate positively with tumor weight. Sense ICAM-1 transfectants are more proliferative and induce more blood vessel formation than mock and antisense transfectants in nude mice. Because expression of ICAM-1 does not affect tumor cell growth in vitro, the angiogenic activity of sICAM-1 produced by sense ICAM-1 transfectants may be involved in the stimulation of tumor growth. Therefore, sICAM-1 may perform dual functions that are essential for tumor growth: angiogenesis and escape from immune surveillance.

Molecular cloning and characterization of splice variants of human RAD50 gene.

In this report, splice variants of human RAD50 (hRAD50) were cloned and characterized. A Northern blot survey identified two transcripts that hybridized to a hRAD50 cDNA clone, an upper faint band (5.9kb) and lower dense band (4.6kb). cDNA clones (hRAD50-2, 4.6kb) encompassing the entire hRAD50 transcript but having a shorter 3'-untranslated region (3'UTR) than the previously reported hRAD50-1 cDNA (5.9kb; Dolganov, G.M., Maser, R.S., Novikov, A., Tosto, L., Chong, S., Bressan, D.A., Petrini, J.H.J., 1996. Human Rad50 is physically associated with human Mre11: Identification of a conserved multiprotein complex implicated in recombinational DNA repair. Mol. Cell. Biol. 16, 4832-4841.) were isolated. The presence of AU-rich sequences in the 3'UTR of hRAD50-1, which define mRNA instability and Northern results, suggest that hRAD50-2 is the major transcript of hRAD50. A third alternative splice variant that lacks the ATP-binding domain was also identified (hRAD50-3, approximately 4.5kb). Expression of hRAD50-3 transcript was detected in all tissues examined by RT-PCR (reverse transcriptase-polymerase chain reaction) and nested DNA-PCR analyses. Expression of hRAD50 partially rescued the MMS (methyl methanesulfonate)-sensitive phenotype in rad50 mutant yeast, whereas hRAD50-3 did not show complementation. These data suggest that the hRAD50-3 does not repair DNA double-strand breaks most likely due to its inability to bind ATP, and to bind damaged DNA. The existence of these alternative splice forms is potentially important in regulation of the biological activity of the DNA recombinational repair gene, hRAD50.

Dietary and anthropometric determinants of plasma lipoproteins during a long-term low-fat diet in healthy women.

Long-term (1 y) effects of dietary fat intake on lipoprotein metabolism were determined in 72 healthy women receiving either a 15%-fat diet (n = 34) or usual diet (n = 38). Every three months food records, weight, waist-hip ratio (W:H), percent body fat, fasting plasma triglyceride, cholesterol (C), high-density-lipoprotein cholesterol (HDL-C), HDL2-C, and HDL3-C; apolipoprotein B and A-I, and postheparin lipoprotein lipase (LPL) and hepatic triglyceride lipase activities were determined. In one year, the low-fat-diet (LFD) group had 17% and the non-intervention-diet group had 36% dietary fat. The LFD group showed decreases in cholesterol: 7% TC, 13% low-density lipoprotein (LDL), and 8% HDL. Apolipoprotein A-I, decreased early. Apolipoprotein B did not change. Plasma triglyceride correlated with weight. Percent body fat and W:H correlated with the total and LDL-C. Changes in HDL-C and/or HDL2-C and LPL correlated directly with the changes in dietary fat and inversely with dietary carbohydrate. Changes in total-C or LDL-C correlated with the changes in weight and W:H, but not with the changes in nutrient intake.

Biliary ascariasis: MR cholangiography findings in two cases.

We describe the imaging features of two cases of biliary ascariasis. Ultrasonography and CT showed no specific abnormal findings, but MR cholangiography clearly demonstrated an intraductal linear filling defect that led to the correct diagnosis. MR cholangiography is thus a useful technique for the diagnosis of biliary ascariasis.

Usefulness of MR imaging for diseases of the small intestine: comparison with CT.

OBJECTIVE: To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT. MATERIALS AND METHODS: Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared. RESULTS: MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients. CONCLUSION: MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction.

Increase of modified retrograde to antegrade flow ratio on doppler ultrasounds of the hepatic vein indicating tricuspid regurgitation during follow-up of liver transplantation: correlation with echocardiographic results.

The purpose of this study was to explore the best parameter of hepatic vein (HV) Doppler ultrasounds (DUS) that correlated with echocardiographic findings of and particularly the optimal cutoff value for tricuspid regurgitation (TR) following liver transplantation (LT). Thirty-six patients underwent echocardiography and DUS after LT from January 2006 to July 2007. Echocardiographic records were searched for TR grade and peak velocity of TR flow. The HV DUS parameters included peak velocity of retrograde flow (R), peak velocity of antegrade flow (A), the difference between R and A (R-A), the ratio of R to A (R/A ratio), and a modified R/A ratio, namely, the product of the R/A ratio and the R/A duration ratio. Correlation tests and receiver-operator characteristic analyses explored their interrelations and to obtained cutoff values to diagnose moderate and severe TR. TR grade best correlated with the modified R/A ratio (rho = 0.585), followed by the R/A ratio (rho = 0.503) and R (rho = 0.455). The modified R/A ratio was the most accurate parameter for the diagnosis of moderate and severe TR (Az = 0.825 and 0.895, respectively); its cutoff value was > or =0.11 for moderate TR (sensitivity and specificity both 77.78%) and 0.13 for severe TR (sensitivity, 100%; specificity, 81.2%). The modified R/A ratio best correlated with echocardiographic results of TR, although the strength of correlation was only moderate. Additionally, the modified R/A ratio was an accurate DUS parameter to diagnose moderate and severe TR among patients following LT.

Gastric schwannomas: radiological features with endoscopic and pathological correlation.

AIM: To describe the radiological, endoscopic, and pathological findings of gastric schwannomas in 16 patients. MATERIALS AND METHODS: The radiological, endoscopic, and pathological findings of 16 surgically proven cases of gastric schwannoma were retrospectively reviewed. All patients underwent computed tomography (CT) and four patients were evaluated with upper gastrointestinal series. Two radiologists reviewed the CT and upper gastrointestinal series images by consensus with regard to tumour size, contour, margin, and growth pattern, the presence or absence of ulcer, cystic change, and the CT enhancement pattern. Endoscopy was performed in eight of these 16 patients. Six patients underwent endoscopic ultrasonography. Pathological specimens were obtained from and reviewed in all 16 patients. Immunohistochemistry was performed for c-kit, CD34, smooth muscle actin, and S-100 protein. RESULTS: On radiographic examination, gastric schwannomas appeared as submucosal tumours with the CT features of well-demarcated, homogeneous, and uncommonly ulcerated masses. Endoscopy with endoscopic ultrasonography demonstrated homogeneous, submucosal masses contiguous with the muscularis propria in all six examined cases. On pathological examination, gastric schwannomas appeared as well-circumscribed and homogeneous tumours in the muscularis propria and consisted microscopically of interlacing bundles of spindle cells. Strong positivity for S-100 protein was demonstrated in all 16 cases on immunohistochemistry. CONCLUSION: Gastric schwannomas appear as submucosal tumours of the stomach and have well-demarcated and homogeneous features on CT, endoscopic ultrasonography, and gross pathology. Immunohistochemistry consistently reveals positivity for S-100 protein in the tumours.

Secretin-stimulated MRCP.

Secretin-stimulated magnetic resonance cholangiopancreatography not only facilitate the depiction of anatomic variations or morphologic changes of the pancreatic duct in the normal and diseased pancreas but also help assessing functional abnormalities of the exocrine pancreas. In this article, we illustrate findings of normal pancreas and various pancreatic diseases on magnetic resonance cholangiopancreatography after secretin stimulation.

Autoimmune pancreatitis: radiologic findings in 20 patients.

BACKGROUND: Autoimmune pancreatitis is a new clinical entity that is characterized by peculiar histopathologic and laboratory findings and by a dramatic clinical response to corticosteroid therapy. We evaluated the radiologic findings of autoimmune pancreatitis. METHODS: Computed tomographic, magnetic resonance imaging, endoscopic retrograde cholangiopancreatographic, and ultrasonographic findings of 20 patients with autoimmune pancreatitis in our hospital between November 2000 and December 2003 were retrospectively reviewed regarding changes and ancillary findings in the pancreatic parenchyma, the main pancreatic duct, peripancreatic vessels, and distal common bile duct. In addition, follow-up images were reviewed for changes in any abnormality seen on the initial examinations. RESULTS: Pancreatic parenchymal enlargement was invariably seen that was diffuse (n = 19) or focal (n = 1), with homogeneous contrast enhancement on computed tomography (n = 20) and magnetic resonance imaging (n = 15). Capsule-like rim enhancement was seen in six patients. There was focal (n = 18) or diffuse (n = 2) narrowing of the main pancreatic duct and it was usually multifocal (n = 17) in the former. Narrowing of the peripancreatic veins was seen in 14 patients. There was tapered (n = 15) or abrupt (n = 3) narrowing of the distal common bile duct in 18 patients, with contrast enhancement of the narrowed segment in eight. Invariably, changes in the pancreatic parenchyma, main pancreatic duct, peripancreatic vessels, and common bile duct were normalized on follow-up studies after steroid therapy. CONCLUSION: In this series, common radiologic findings of autoimmune pancreatitis were (a) diffuse pancreas enlargement, (b) multifocal narrowing of the main pancreatic duct, (c) narrowing of peripancreatic veins, and (d) tapered narrowing of the distal common bile duct with frequent contrast enhancement. These findings were usually reversible with steroid therapy.

Abdominal cavernous Iymphangiomas: CT findings.

Two adult patients with histopathologically proved cavernous lymphangiomas and one adult patient with lymphangiomas of strongly presumed cavernous type by cytologic and computed tomographic findings are reported. On computed tomograms, multiple, aggregated, small, and tiny cysts without a solid portion, along the lymphatic channels are characteristic computed tomographic findings for cavernous lymphangiomas.

Urokinase concentration in the renal artery and vein.

To compare the fibrinolytic activity between the renal artery and vein and the systemic circulation, we measured tissue-type plasminogen activator (t-PA), urokinase and total fibrinolytic activity in the blood samples from both the left and right renal artery and vein and the anterior cubital vein of 7 kidney donors. Englobulin fibrinolytic activity was significantly higher in the renal vein [106.6 +/- 5.6 blood activator units (BAU)] than in the renal artery (90.6 +/- 4.1 BAU; p less than 0.001) and cubital vein (94.3 +/- 6.3 BAU, p less than 0.005), but there was no difference between renal artery and cubital vein. t-PA Ag was 2.9 +/- 1.1 ng/ml in the renal vein, 2.6 +/- 1.0 ng/ml in the renal artery and 2.6 +/- 1.1 ng/ml in the cubital vein. There was no difference between renal artery, renal vein and cubital vein. Urokinase was significantly higher in the renal vein (3.3 +/- 0.4 ng/ml) than in the renal artery (2.4 +/- 0.4 ng/ml; p less than 0.001) and cubital vein (2.6 +/- 0.4; p less than 0.005), but there was no difference between the renal artery and cubital vein. In all cases, there was no difference in the fibrin(ogen) degradation product concentration between the renal artery and vein and the cubital vein. These findings suggest that the kidney may be an essential organ for providing urokinase to the systemic circulation.

Ruptured hepatoma: detection with lipiodol angiography.

Hemorrhage from ruptured hepatoma is a serious complication. Transcatheter arterial embolization (TAE) is a choice of the treatment for control of hemorrhage. But conventional angiography may be useless for detection of bleeding site from ruptured hepatoma. We report two cases of ruptured hepatoma with detection of bleeding site by Lipiodol angiography.

Intraperitoneal seeding from hepatoma.

We report three cases of intraperitoneal seeding from hepatoma. Manifestation of intraperitoneal seeding from hepatoma were intraperitoneal masses (N = 2) and peritoneal thickening (N = 1). Main vascular feeder to intraperitoneal masses was omental branches of the gastroduodenal artery and/or the superior mesenteric artery.

Mirizzi syndrome: evaluation by MRI imaging.

We report three cases of Mirizzi syndrome diagnosed by MR imaging. MR cholangiography revealed dilation of the intrahepatic bile ducts, narrowing of the common hepatic duct, the level of obstruction, and the location of gallstone in the cystic duct. MR showed thickening of the gallbladder wall and the pattern of wall enhancement. MR evaluation with MR cholangiography sequences proved to be useful in these patients with Mirizzi syndrome.

Budd-Chiari syndrome: hepatic venous obstruction by an elevated diaphragm.

We describe two cases of Budd-Chiari syndrome detected by magnetic resonance imaging that resulted from compression of the inferior vena cava by an elevated right hemidiaphragm. Magnetic resonance images demonstrated elevation of the right hemidiaphragm and medial deviation of the inferior vena cava with short segmental narrowing. The hepatic veins and inferior vena cava were patent but discontinuous. Hepatic venous drainage was assisted by multiple large intrahepatic collaterals.

Computed tomographic findings of ruptured hepatic malignancy.

Massive hemorrhage from ruptured hepatocellular carcinoma is uncommon. We report our experience in three cases of ruptured hepatocellular carcinoma diagnosed by computed tomography (CT). CT was useful in detecting ruptured hepatocellular carcinoma showing the parenchymal tumor per se, defining the extent of the hematoma, and showing serial density changes with the age of the hematomas.

Hepatic MR imaging: comparison of 2D and 3D gradient echo techniques.

BACKGROUND: To compare fat-suppressed three-dimensional gradient echo (3D-GRE) and two-dimensional gradient echo (2D-GRE) techniques for hepatic magnetic resonance imaging. METHODS: For 107 patients with suspected focal hepatic lesions, unenhanced 2D-GRE multislice in-phase and opposed-phase images and 3D-GRE images were obtained. Two radiologists independently and in random order reviewed the images. Quantitative analysis compared contrast-to-noise ratio (C/N) of liver masses and of the liver to spleen and signal-to-noise ratio (S/N) of the liver. Subjective grading of lesion conspicuity, confidence for lesion detection, artifacts, and overall image quality were also evaluated. RESULTS: Conspicuity and confidence for focal lesions was statistically significantly higher on 3D-GRE than on 2D-GRE images. Liver-to-spleen C/N was higher on 3D-GRE images than on in-phase and opposed-phase 2D-GRE images (p < 0.01). Liver S/N was higher on in-phase 2D-GRE images than on 3D-GRE and opposed-phase 2D-GRE images (p < 0.001). Lesion-to-liver C/N was higher on 3D-GRE images than on 2D-GRE images for nonsolid lesions (p < 0.05), but there was no significant difference for solid lesions. Motion and pulsation artifacts were significantly fewer on 3D-GRE images, but graininess and shading were significantly higher. Overall image quality was not significantly different for the three sequences. CONCLUSION: Fat-suppressed 3D-GRE sequences can afford comparable or better image quality than 2D-GRE images and may have the potential to detect more focal hepatic lesions.