Foam sclerotherapy using polidocanol (aethoxysklerol) for preoperative portal vein embolization in 16 patients.

PURPOSE: To evaluate the clinical safety and effectiveness of foam sclerotherapy using polidocanol for preoperative portal vein embolization (PVE) before hemihepatectomy of the liver. MATERIALS AND METHODS: From March 2006 to October 2008, foam sclerotherapy using polidocanol was performed in 16 patients (male-to-female ratio of 12:4, age range 48-75 years [mean 62]) for PVE. Patients were diagnosed with Klatskin tumor (n = 13), gallbladder (GB) cancer (n = 2), or hepatocellular carcinoma (HCC) (n = 1). The foam was composed of a 1:2:1 ratio of 3% polidocanol (Aethoxysklerol; Kreussler Pharma, Wiesbaden, Germany), room air, and contrast media (Xenetix 350; Guerbet, Aulnay-Sous-Bois, France). The total amount of polidocanol used (2 to 8 mL [mean 4.6]) varied according to the volume of the target portal vein. We calculated the volume of future liver remnant (FLR) before and after PVE and evaluated complications associated with the use of polidocanol foam sclerotherapy for PVE. RESULTS: Technical success was achieved in all patients. All patients were comfortable throughout the procedure and did not experience pain during sclerotherapy. No periprocedural morbidity or mortality occurred. Patients underwent a liver dynamic computed tomography (CT) scan 2-4 weeks after PVE. FLR increased significantly after PVE using polidocanol foam from 19.3% (range 16-35%) before PVE to 27.8% (range 23-42%) after PVE (p = 0.001). All patients were operable for hemihepatectomy of the liver and achieved effective resection. CONCLUSION: Foam sclerotherapy using polidocanol is clinically safe and effective for preoperative PVE.

Radiologic findings of lung lobe torsion in reconstructed multidetector computed tomography image lead to early detection.

Torsion of the remaining lung lobe after lobectomy is a rare complication, and sometimes, diagnosis can be difficult. But early detection is important to prevent resection and fatal complication. We present a case of left lower lobe torsion with reconstructed image of multidetector computed tomography (MDCT) findings, which propose a possibility of early detection on retrospective review after surgical reduction. Multiplanar reconstruction of MDCT image, 3-dimensional CT angiography, and CT bronchography could provide important diagnostic clues.

Evaluation of coronary artery in-stent restenosis by 64-section computed tomography: factors affecting assessment and accurate diagnosis.

PURPOSE: To determine factors affecting the ability of 64-multislice computed tomography (MSCT) to detect, assess, and accurately diagnose significant coronary arterial in-stent restenosis (ISR). MATERIALS AND METHODS: The institutional review board approved this study and waived informed consent. Sixty patients underwent CT coronary angiography using 64-MSCT, after implantation of coronary artery stents (n=91). We assessed diagnostic accuracy for ISR with CT in comparison with conventional coronary angiography as the gold standard, visually and with measurement of in-stent coronary lumen density. Possible factors that influenced the diagnostic performance of CT were evaluated, which included image quality (IQ), stent characteristics, and location. RESULTS: Sixty-nine stents (75.8%) were assessable. Low IQ, location in the left circumflex coronary artery, and narrow stent diameter were associated with poor assessment (P<0.05). In stents that could be assessed, sensitivity, specificity, positive predictive value, and negative predictive value of 64-MSCT were 90.0%, 73.5%, 58.1%, and 94.7%, respectively, for significant ISR. The diagnostic accuracy in assessable stents showed a significant increase with better IQ, thinner strut thickness, and nondrug eluting stent. False-positive diagnoses of ISR by CT were explained by coronary lumen density measurements. CONCLUSIONS: Evaluation of stents by 64-MSCT is not recommended in stents with diameters of < or = 2.75 mm or stents located at the left circumflex coronary artery. The diagnostic accuracy of 64-MSCT is affected by IQ and strut thickness in assessable stents. Significant ISR can be excluded with high reliability in selected patients.

Comparison of two different injection rates of gadoxetic acid for arterial phase MRI of the liver.

PURPOSE: To compare two different injection rates for gadoxetic acid-enhanced hepatic arterial phase images on hepatic dynamic MRI. MATERIALS AND METHODS: Hepatic arterial phase images were obtained after an intravenous bolus injection of gadoxetic acid at a rate of 1 mL/second in 62 patients and 2 mL/second in 64 patients on a 3 Tesla MR scanner using a test-bolus injection method. The signal-to-noise ratios (SNR) of the liver, portal vein, hepatic vein, aorta, spleen and pancreas were measured. The contrast-to-noise ratio (CNR) of hypervascular hepatic tumors was calculated. Two radiologists independently scored items to evaluate image quality of hepatic arterial phase and detected hypervascular hepatocellular carcinoma (HCC). RESULTS: The SNR of the aorta on the arterial phase images was significantly higher in the 1 mL/second group (235.43 +/- 82.59) than in the 2 mL/second group (190.94 +/- 96.90, P < 0.05). The SNRs of the liver, spleen and pancreas, the CNRs of hypervascular hepatic tumors, the detection rate of hypervascular HCC and subjective ratings for the optimal arterial enhancement were comparable between the two groups. CONCLUSION: Injection rates of 2 mL/second and 1 mL/second provided comparable image qualities on arterial phase images of hepatic dynamic MRI using gadoxetic acid.