Dynamic Images for Prediction of Therapeutic Efficacy of Hepatocellular Carcinoma Treated with Transcatheter Oily Chemoembolization

PURPOSE: To predict the therapeutic efficacy of transcatheter oily chemoembolization(TOCE) in the treatment. MATERIALS AND METHODS: We reviewed the findings of 24 dynamic CT or MR scans examined for the purpose of diagnosis before TOCE, and follow-up CT scans obtained after this procedure. In 24 patients (M:F=20:4) with a mean age of 52.2 years, 43 nodular HCCs with a diameter of 5 cm or less were present. The patients underwent double dynamic CT or MR imaging as one arterial phase 30 seconds after the intravenous injection of contrast media, and this was followed by a delayed phase 5 minutes fter injection. HCCs were then classified as one of four types: Type I, high and low attenuation or intensity during the arterial and delayed phase, respectively; Type II, iso- and low; Type III, iso- and high; and Type IV, high and iso-. In addition, we classified the degree of lipiodol accumulation by HCC nodules as either Grade 5 (fullmoon-like lipiodolization), Grade 2 (about 40%), or Grade 1 (about 20%), as seen on follow-up CT scans after TOCE. RESULTS: Type I provided an accuracy of 72.1% considering to more than 50% lipiodol accumulation. However, a single finding demonstrating high atenuation or intensity during the arterial phase gave an accuracy of 79.1% better than that of Type I. CONCLUSION: A finding of high attenuation or intensity during the arterial phase, as seen on dynamic CT or MR images, provides the best information about the therapeutic efficacy of HCCs treated by means of with TOCE.

Respiratory Distress Synd rome: Comparison between Radiographic Finding after Surfactant Replacement Thera py and Prognosis

PURPOSE: To evaluate the relationship between radiographic findings after surfactant replacement therapy and prognosis in newborns with respiratory distress syndrome (RDS). MATERIALS AND METHODS: The chest radiographs and medical records of 78 infants [body weight 840-3600g, mean 1682g, gestational age 20 -38 (mean, 31) weeks] who had been treated with surfactant were retrospectively analysed. Surfactant was applied 1 -12 (mean, 5) hours after birth. By comparing pre-and post-surfactant radiographs, radiographi changes were graded as either uniform bilateral improvement (grade 1), asymmetrical unilateral improvement (grade 2), or no improvement (grade 3). Complications such as barotrauma, bilateral diffuse consolidation, or intracranial hemorrhage were tabulated. We correlated the prognosis with (a) the radiographic improvement pattern, (b) the time of surfactant application, and (c) the incidence of pulmonary complications, respectively. RESULTS: Forty-six (59%) of 78 infants survived, and 32 (41%) died. The survivors comprised 38 infants in group 1 (67%, n=57), six in group 2 (46%, n=13), and two in group 3 (25%, n=8) (p 0.05). Infants with barotrauma had a lower survival rate (42%, 10/24) than those not suffering from this condition (67%, 36/54) (p<0.05). The condition oc-curred in 12 (21%) of 57 infants in group 1, six (46%) of 13 in group 2, and six (75%) of eight in group 3 (p <0.05). Eleven(92%) of 12 infants with pulmonary hemorrhage, seven (100%) of seven with intracranial hemorrhage above grade 3, and seven (41%) of 17 with sepsis died. CONCLUSION: The radiographic changes occurring after surfactant replacement therapy correlated closely with the incidence of barotrauma and the prognosis of newborns with respiratory distress syndrome. Close observation of follow-up radiographic findings plays an important role in therapy and prognosis.

CISS MR Imaging Findings of Epidermoid Tumor: Comparison with Spin-Echo Images

PURPOSE: To evaluate CISS MR imaging findings of epidermoid tumor in comparison with conventional spin-echoimages. MATERIALS AND METHODS: We studied 6 cases of epidermoid tumor in the subarachnoid space. We used a 1.5TMR unit to obtain CISS images(TR/TE/FA ; 12.3msec/5.9 msec/700) and T1- and T2-weighted spin-echo images. CISS MRimaging findings were evaluated with respect to tumor's signal intensity, contour, and relation with adjacentstructures. Conspicuity of the tumor was compared between CISS and spin-echo images. A quantitative analysis wasperformed by measuring tumor to CSF contrast. In qualitative analysis, three radiologists independently comparedCISS image and conventional spin-echo images for visibility of the tumor and graded them into three categories(poor, good, and excellent). RESULTS: Epidermoid tumors were located in the cerebellopontine angle in 4 cases, theprepontine cisstern in 1 case, and the cerebellopontine angle-prepontine cistern in 1 case. The tumors werehyperintense relative to brain parenchyma and hypointense relative to CSF on CISS images, were lobulated, encasedadjacent cranial nerve and vessels, and invaginated into brain parenchyma. In qualitative analysis, CISS imagesshowed clear demarcation between tumor and CSF, exact tumor extension, and tumor's relation with cranial nervesand vessels better than conventional spin-echo images. In quantitative analysis, the mean contrast values of tumorto CSF on T1-, T2-weighted images, and CISS images were 0.12, 0.06, and 0.52, respectively. The contrast value forCISS images was significantly higher than that for T1- and T2-weighted images (P<0.05) . CONCLUSIONS: Epidermoid tumors in the subarachnoid space are better demonstrated on CISS images than on conventional spin-echoimages. This special MR sequence can be added as a routine protocol in the diagnosis of subarachnoid epidermoidtumor.