CT-guided percutaneous chemical ablation of adrenal neoplasms.

OBJECTIVE: The objective of our study was to evaluate the feasibility and effectiveness of percutaneous chemical ablation of primary and metastatic adrenal neoplasms under CT guidance. MATERIALS AND METHODS: Thirty-seven patients with 46 adrenal tumors underwent CT-guided percutaneous chemical ablation. The average (+/- SD) tumor diameter was 4.2 +/- 2.0 cm. Acetic acid was injected in lesions with a diameter of more than 3 cm, and ethanol was injected in lesions with a diameter of less than 3 cm. Eleven adrenal lesions were nonfunctional adenomas, six lesions were corticosteroid adenomas (bilateral lesions in one patient), nine lesions were aldosteronomas (bilateral lesions in two patients), and 20 were metastases (bilateral metastases in six patients). RESULTS: Tumor volume decreased gradually during the first 2 years after the procedure. For primary tumors, a complete response (CR) rate of 92.3% (24/26) and a partial response (PR) rate of 7.7% (2/26) were obtained, but for metastasis, a CR rate of 30% (6/20) and PR rate of 70% (14/20) were obtained 24 months after therapy. The level of corticosteroid in five patients (six tumors) with Cushing's syndrome was in the normal range 3 months after the procedure. Seven patients (nine tumors) with Conn's syndrome began receiving oral antihypertensive medications during the first month after the procedure to maintain normal blood pressure and the dose was gradually decreased after 1 month. No severe complications were encountered. CONCLUSION: CT-guided percutaneous chemical ablation of adrenal tumors is an effective, minimally invasive, and easily performed procedure.

Hepatic perfusion disorders: etiopathogenesis and related diseases.

In this article, we have reviewed the hepatic perfusion disorder (HPD), etiopathogenesis of HPD and corresponding diseases. Review of the literature was based on computer searches (PubMed, Index Medicus) and personal experiences. We considered HPD reflects perfusion differences due to redistribution of arterial blood flow among segments, subsegments and lobes of the liver. The plain CT scan findings of HPD manifests as triangular or wedge-shaped areas of low attenuation. On contrast-enhanced CT scan, HPD manifests multiple (or single) transient wedge-shaped, rotundloid or irregular appearance, homogeneous hyperattenuation (in less cases, hypoattenuation) during the hepatic arterial phase (HAP) and isoattenuated or slightly hyperattenuated areas during the portal arterial phase. Dynamic enhanced magnetic resonance (MR) features are similar to enhanced CT scan. Angiographic findings include non-opacification of portal vein on portograms or wedge-shaped segmental staining in arterial and parenchymal phases on hepatic angiograms. The causes of HPD are arterioportal shunts (APS), intrahepatic vascular compressions and portal vein occlusion, steal phenomenon by hypervascular tumors, vascular variations and any other unknown reasons. It is very important for radiologists to be familiar with the various appearances of HPD to avoid false-positive diagnosis of pseudolesions and not to overestimate the extent of the disease.