Hepatic arterial mapping by multidetector computed tomographic angiography in living donor liver transplantation.

PURPOSE: Our aims were to present the hepatic arterial variations that were detected with computed tomographic angiography (CTA) and confirmed by operation in living liver donors and to emphasize the usefulness of CTA in the assessment of hepatic arterial anatomy. MATERIALS AND METHODS: The donors of 100 patients (46 women and 54 men) who had undergone a living donor liver transplantation in a (blinded) hospital between July 2004 and June 2007 were evaluated. The age of the donors ranged from 18 to 63 years (mean, 39 years). The CTA images obtained by a 16-slice multidetector CT before the transplantation procedure were retrospectively evaluated for arterial variations, and the results were compared with the results of the operation. RESULTS: In 59 donors (59%), classic hepatic arterial anatomy was observed. In the remaining 41 donors (41%), various arterial variations were determined. In 11 of the donors (11%), variations were not compatible with the description of Michel's classification. In all of our patients, CTA findings were confirmed with operational findings. Our complication rate was 1%. Only 1 of the patients who had undergone the transplantation developed hepatic arterial thrombus, and the remaining 99 patients had no arterial complications. CONCLUSIONS: The course of the vascular structures before live donor liver transplantation is essential for planning and success of the operation. Our study showed that multidetector CTA can be used successfully in hepatic artery imaging of liver transplantation donors as a noninvasive method.

Computed tomography findings in diseases of the adrenal gland.

The adrenal gland is a common site of disease, with an abnormality prevalence as high as 9% in autopsy series. With the increasing use of CT, adrenal lesions are frequently found in the daily practice of radiology and are diagnosed in up to 5% of CT examinations performed for varied reasons. Imaging features on CT can establish a specific diagnosis of many of these lesions, including myelolipoma, hematoma and cysts. Once a diagnostic dilemma, now adenomas can be accurately diagnosed using unenhanced CT, chemical shift magnetic resonance imaging and CT contrast washout analysis. Because the adrenal gland is also a frequent site of metastasis, recent literature has focused on imaging characterization of adrenal masses for differentiation of adenomas from metastases. In patients without known malignancy, most adrenal lesions are benign and a specific diagnosis can now be made on the basis of imaging features. It is important to understand the prevalence of adrenal abnormalities because the gland is a common site of disorders, and the increased use of cross-sectional imaging has increased the frequency of detection of adrenal lesions. The prevalence of disease is important in predicting the risk of malignancy when an adrenal mass is discovered in a patient without known cancer. Detection of adrenal gland diseases has increased substantially with the advent and widespread use of imaging techniques. Although several imaging modalities can be used, CT has a central role in both detection and differential diagnosis of an adrenal lesion. The aim of this article is to review the CT findings of adrenal gland diseases.

Presence of obestatin in breast milk: relationship among obestatin, ghrelin, and leptin in lactating women.

OBJECTIVE: The peptide hormones ghrelin and leptin have been found in blood and breast milk. This study was undertaken to investigate whether breast milk also contains obestatin, which is derived from the same gene as ghrelin but has opposite actions, and to characterize the relations among serum and milk ghrelin, obestatin, and leptin levels in lactating mothers. METHODS: Venous blood, colostrum, and mature milk were obtained from healthy lactating women (n = 31) just before suckling. The ghrelin and obestatin concentrations were determined by radioimmunoassay. Leptin levels were measured by enzyme-amplified sensitivity immunoassay. RESULTS: Obestatin levels in colostrum (538.9 pg/mL) and mature milk (528.5 pg/mL) were more than twice the corresponding blood levels (270.3 and 289.4 pg/mL, respectively). In contrast, leptin levels in colostrum (2.01 ng/mL) and mature milk (2.04 ng/mL) were more than five-fold lower than the corresponding blood levels (11.54 ng/mL). There was no correlation between breast milk ghrelin levels and leptin (r = -0.18, P > 0.05). However, there was a positive correlation between leptin levels in breast milk and blood (r = 0.369, P < 0.05). CONCLUSION: The origin of milk obestatin is not currently known, but it comes from the blood or breast and may drain through the mammary glands into the milk. Ghrelin, obestatin, and leptin in the milk may directly affect appetite and their levels may be related to the regulation of energy balance and the pathogenesis of obesity.

Renal replacement lipomatosis: MR findings in one case.

Replacement lipomatosis of the kidney is the result of severe atrophy or destruction of the renal parenchyma, often caused by calculous disease with secondary marked proliferation of renal sinus, renal hilus, and perirenal fatty tissue. Different diagnostic tools have been used to define this entity, with ultrasonography (US), i.v. pyelography (IVP) and computed tomography (CT) used most commonly. We report MR urography and MR appearance of replacement lipomatosis in a 38-year-old man. We think that it combines the advantages of IVP, US and CT.

Comparison of peritoneal tumor imaging using conventional MR imaging and diffusion-weighted MR imaging with different b values.

PURPOSE: The aim of this study was to evaluate the utility of DW MRI with two different b values in identifying peritoneal tumors in oncology patients. MATERIALS AND METHODS: Nineteen patients with known malignancy underwent abdominal and pelvic MRI before surgery. MRI included free-breathing DWI with b values of 400 and 800 s/mm2, T1-weighted fat-suppressed spoiled gradient-echo, T2-weighted fat-saturated turbo spin-echo, and 5-min delayed gadolinium-enhanced imaging. Two observers reviewed images for peritoneal tumors at ten anatomic sites within consensus. The results of laparatomy and histopathological evaluation were compared with MRI results. Sensitivity, specificity, and accuracy of identifying peritoneal metastases were calculated for conventional MRI, combined DWI with a b value of 400 s/mm2 and conventional MRI, and combined DWI with a b value of 800 s/mm2 and conventional MRI by consensus of two observers. RESULTS: One-hundred and twenty-five peritoneal metastasis sites were confirmed by surgical and histopathological findings. Conventional MRI alone identified 72 peritoneal metastases (sensitivity, 0.58; specificity, 0.87; accuracy, 0.67). Combined DWI with a b value of 400 s/mm2 and conventional MRI revealed 106 peritoneal metastases (sensitivity, 0.85; specificity, 0.88; accuracy, 0.85). Finally, combined DWI with a b value of 800 s/mm2 and conventional MRI revealed 103 peritoneal metastases (sensitivity, 0.83; specificity, 0.94; accuracy, 0.86). CONCLUSION: DWI with a high b value provides complementary information that can improve the detection of peritoneal tumors when combined with conventional MRI. We recommend combined MRI and DWI with a high b value for increasing the sensitivity and accuracy of the preoperative detection of peritoneal tumors.

Images in clinical urology. Why we did not use left side for this donor.

We describe a case of an unusual variation of the double retroaortic left renal vein discovered during routine donor examination of the abdomen by multidetector computed tomography. A 53-year-old man underwent evaluation in our department as a potential renal donor for his brother who had end-stage renal failure. Multidetector computed tomography angiography showed double retroaortic left renal veins. This can increase the potential for serious morbidity and mortality in the donor. We prefer right kidney for potential donation. Multidetector computed tomography is the method of choice in the evaluation of renal donation.

Coronary artery-pulmonary vein fistula diagnosed by multidetector computed tomography.

Coronary artery fistulas are rare congenital or acquired coronary artery anomalies that can originate from any of the three major coronary arteries and drain in all the cardiac chambers and great vessels. Multidetector computed tomography has provided cross-sectional anatomy of the heart with excellent spatial and temporal resolution, which shows the anatomical and functional changes in cardiac disorders. Here, the first case of noniatrogenic coronary artery to pulmonary vein fistula depicted by multidetector computed tomography has been presented.

Infra-renal abdominal aorta hypoplasia in a case of Down syndrome depicted by multidetector computed tomography angiography.

We report the case of a 3-day-old newborn with Down syndrome suffering from congenital infra-renal aortic hypoplasia. To our knowledge, this is the first report of a Down syndrome case with infra-renal abdominal aorta hypoplasia depicted by multidetector computed tomography angiography. In cases with no palpable pulsations in the lower extremities, multidetector computed tomography angiography is a fast and reliable diagnostic tool for the evaluation of distal aortic lesions.

[Diagnostic value of HASTE technique and excretory MR urography in urinary system obstructions]. / Uriner sistem obstrüksiyonlarinda HASTE tekniginin ve ekskretuar MR ürografinin tani degeri.

PURPOSE: To compare the diagnostic value of static-liquid magnetic resonance urography (MRU) in T2-weighted HASTE (half-fourier acquisition single-shot turbo spinecho) sequences and T1-weighted excretory MRU with i.v. diuretic and contrast material injection. MATERIALS AND METHODS: The study included 29 patients (15 men, 14 women). Thirty-one urinary obstructions were detected on intravenous urography (IVU) two of which were due to bilateral obstructions. The cases were evaluated by T2 HASTE sequences combined with T1-weighted FLASH 3D sequences after i.v. diuretics and gadolinium DTPA injection. RESULTS: Thirty-one urinary obstructions were detected on IVU. Thirty of which were confirmed by T2-weighted MRU and all were confirmed by excretory MRU. In one nonobstructive case, unilateral grade 1 ureteropelvicaliectasis related to ureteral stone was falsely interpreted by both sequences. There were no statistical differences among IVU, T2-weighted MRU and excretory MRU in detecting the obstruction levels. In 22 cases with ureteral stones, 12 of which were confirmed by T2-weighted MRU and 18 cases were confirmed by excretory MRU. Sensitivity and specificity fo detecting the ureteral stones as a cause of obstruction with T2-weighted MRU were 50%and 89% and with excretory MRU were 77% and 89% respectively. In 9 obstructive cases due to causes other than the stones, 8 of which were detected by T2-weighted MRU and all of which were detected by excretory MRU. Sensitivity and specificity for detecting the causes other than the stones with T2-weighted MRU were 96% and 100% and with excretory MRU were 100% and 100% respectively. CONCLUSION: MRU is a useful thechnique revealing high-quality images to determine the urinary system obstructions to obtain the causes of obstructions. MRU should be used as an alternative imaging technique in cases which IVU can not be applied. The existence and the causes of obstruction can be detected by HASTE MRU. Excretory MRU can supply additional information in cases with functional kidneys where the cause of obstruction can not be revealed by HASTE MRU.