Diffusion-weighted imaging of the liver in assessing chronic liver disease: effects of fat and iron deposition on ADC values.

OBJECTIVE: This study was designed to evaluate whether fat and iron affect the apparent diffusion coefficient (ADC) values of the liver parenchyma in the settings of fibrosis and inflammation. PATIENTS AND METHODS: We evaluated the diffusion-weighted images (DWIs) of 58 patients with chronic liver disease and 48 control subjects. Liver specimens of patients were assessed for fibrosis, necroinflammation, iron, and steatosis. Liver ADCs, spleen ADCs, and normalized liver ADCs (defined as the ratio of the liver ADC to spleen ADC) values were analyzed after stratifying patients with either fibrosis stages or histology activity index (HAI) scores. The relationship between ADC values and histopathological findings was studied using multiple linear regression analysis. RESULTS: The median liver and normalized liver ADC values were significantly lower in higher stages of fibrosis and HAI scores. Compared to the control group, patients with the highest stages of fibrosis and inflammation had significantly higher spleen ADCs. The effect of the fibrosis stage on liver ADC and normalized liver ADC values was significant in the setting of inflammation, whereas the degree of steatosis and iron grade did not affect these ADC values. CONCLUSIONS: ADC values can distinguish both later stages of liver fibrosis and inflammation. There is no significant effect of fat and iron on ADC values. Therefore, DWI may be reliable in evaluating liver fibrosis and inflammation.

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging-guided risk assessment in living donor liver transplant patients with postoperative complications: a pilot study.

OBJECTIVE: To evaluate whether gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI), the measurements of quantitative and qualitative parameters on hepatobiliary phase images can predict the risk of postoperative complications in patients underwent living donor liver transplantation (LDLT) PATIENTS AND METHODS: We obtained Gd-EOB-DTPA-enhanced 3 Tesla MRI before living donor hepatectomy in donors (donor group; n=30) and after LDLT in their recipients (recipient group; n=30). MRIs were evaluated in terms of quantitative and qualitative variables. Quantitative parameters included relative liver enhancement value, biliary signal intensity value, and muscle signal index value. Qualitative parameters included visual evaluation of the liver and biliary enhancement on hepatobiliary phase images. Patients were followed up for postoperative biliary and vascular complications and divided according to the presence and absence of complications. The relationship between MRI parameters and postoperative complications was statistically analyzed. RESULTS: The mean relative liver enhancement values, mean biliary signal values, and muscle signal index were significantly lower in recipients with postoperative complications than those in donors and recipients without complications (p < 0.001). Visual assessments of liver enhancement and biliary signal were also significantly different in recipients with postoperative complications than that in donors and recipients without complications (p < 0.001). CONCLUSIONS: Quantitative and qualitative MRI parameters obtained by Gd-EOB-DTPA-enhanced MRI on hepatobiliary phase images may potentially become a reliable tool for the assessment of the risk for postoperative complications after LDLT.

Surgical Treatment of Portal Vein Thrombosis With the Use of Cadaveric Venous Patch After Donor Hepatectomy: A Case Report.

Live donors should be the priority of transplant professionals to prevent surgery-related morbidity and mortality during living-donor liver transplantation. Portal vein thrombosis after donor hepatectomy is an important complication which can be prevented by careful preoperative as well as perioperative evaluation. If portal vein thrombus occurs after donor hepatectomy, anticoagulation and surgical thrombectomy and even portal vein reconstruction should be kept in mind. Cadaveric venous patches can be used for the reconstruction of narrowed and angulated portal veins. Here we report the surgical treatment of a donor with a cadaveric venous patch who developed portal vein thrombosis after donor hepatectomy.

Multiple dural arteriovenous fistulas involving the cavernous sinus, transverse sinus, sigmoid sinus and spinal drainage: CT angiography findings in 14-year-old boy.

Dural arteriovenous fistulas (DAVF) are rare and constitute 10% to 15% of all intracranial arteriovenous malformations. Only few cases of DAVFs are reported in children. Here is the first case report describing CT angiographic findings in a 14 year old child having multiple DAVFs involving spinal canal, both cavernous and cerebral sinuses.

A 9-year follow-up of a girl with pyridoxine (vitamin B6)-dependent seizures: magnetic resonance spectroscopy findings.

Being an extremely rare condition makes the diagnosis of pyridoxine-dependent seizures (PDS) difficult. Early diagnosis of PDS is very important to prevent unwanted clinical outcomes. Elevated levels of glutamate and decreased levels of y-aminobutyric acid (GABA) in the frontal and parietal cortices are detected in this disorder. Here we present an 18 year old girl with PDS, who was reported 9 years ago with Magnetic Resonance Spectroscopy (MRS) findings. Present and past MRS findings showed a decrease in N-acetyl-aspartate-to creatine ratio on MRS. In this case it is surprising that neuronal damage has been preceded despite the administration of accurate treatment. That can be because of delay in treatment and/or under treatment.

Intraosseous lipoma presenting as a sphenoid sinus mass.

Intraosseous lipoma is an uncommon mesenchymal tumor that is frequently found in appendecular skeleton. In extremely rare conditions, it can appear in sphenoid bone, and only 2 cases have been described in literature until now. We present a case of lipoma in the body of the sphenoid bone mimicking sphenoid sinus tumor. A 16-year-old man presented to Department of Otorhinolaryngology with a complaint of nonspecific headache. There were any clinical findings on physical examination. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed and the diagnosis was made on these imaging findings. Other diagnostic technique, invasive histopathological assessment was not necessary. To our knowledge, this is the first case of lipoma in the body of the sphenoid bone with indentation to sphenoid sinus. The patient has been followed-up radiologically without the need for surgery for two years.