Assessment of iron distribution between liver, spleen, pancreas, bone marrow, and myocardium by means of R2 relaxometry with MRI in patients with beta-thalassemia major.

PURPOSE: To investigate the correlation between the degree of hepatic, splenic, pancreatic, vertebral bone marrow (VBM), and myocardial siderosis, as expressed by relaxation rate (R2 = 1/T2) values, in patients with thalassemia. MATERIALS AND METHODS: R2 relaxation rate values of liver, spleen, VBM, pancreas, and myocardium were estimated in 68 consecutive transfusion-dependent patients with beta-thalassemia major and 10 healthy controls using a respiratory triggered 16-echo Carr-Purcell-Meiboom-Gill (CPMG) spin echo sequence. RESULTS: Hepatic R2 values were significantly increased in all 68 patients; VBM, pancreatic, and myocardial R2 values were increased in 67/68, 35/47, and 47/61 patients, whereas five patients showed decreased pancreatic R2 attributed to fatty degeneration. Of the 39 nonsplenectomized patients, splenic R2 values were decreased in 30 and normal in nine patients. Hepatic R2 values correlated with splenic (r = 0.63, P < 0.001), VBM (r = 0.52, P < 0.001), but not with myocardial and pancreatic R2 values. CONCLUSION: Despite positive correlations between the degree of hepatic, splenic, and VBM siderosis, as expressed by respective R2 values, there was variability of iron distribution patterns in thalassemic patients. Unpredictable patterns of iron distribution may be seen, such as normal signal of the spleen in the presence of siderotic liver, resembling primary hemochromatosis. Fatty degeneration of the pancreas was not uncommon.

Selective hepatic arterial infusion of In-111-DTPA-Phe1-octreotide in neuroendocrine liver metastases.

PURPOSE: The aim of this study is to evaluate the effectiveness of (111)In-DTPA-Phe(1)-octreotide infusions after selective catheterization of the hepatic artery in inoperable metastasised liver, sst(2) receptor-positive neuroendocrine tumours due to the effect of (111)In Auger electron emission, minimising in parallel the toxicity of non-target tissue. METHODS: The average dose per session administered monthly to each patient (17 cases in total) was 6.3+/-2.3 GBq. Repetitions did not exceed 12-fold, except in one case (15 sessions). Response assessment was classified according to the Response Evaluating Criteria in Solid Tumours. CT/MRI scans were performed as baseline before, during and after the end of treatment, and monthly ultrasound images for follow-up measurements. Toxicity (World Health Organization criteria) was measured using blood and urine tests of renal, hepatic and bone marrow function. RESULTS: Complete response was achieved in one (5.9%) patient and partial in eight (47.0%), and disease stabilization in 3 (17.7%) patients; five (29.4%) did not respond. A 32-month median survival time was estimated in 12 (70.5%). Nine of these 12 surviving had a mean target diameter shrinkage from 144+/-81 to 60+/-59 mm. Grade 1 erythro-, leuko- and thrombo-cytopenia occurred in three (17.6%) cases. CONCLUSION: In unresectable metastatic liver lesions positive for somatostatin receptors repeated, transhepatic high doses of (111)In-DTPA-Phe(1)-octreotide show an effective therapeutic outcome. Given the locoregional modality character of the administration technique plus the extremely short range of (111)In Auger and internal conversion electrons emission, no nephro-, liver- or myelo-toxicity has so far been observed.

Bright-dark ring sign in MR imaging of hepatic epithelioid hemangioendothelioma.

We describe the imaging findings in a rare case of multifocal nodular form of hepatic epithelioid hemangioendothelioma on ultrasound (US) and dynamic contrast-enhanced spiral computed tomography (CT) and MRI. The nodules showed multilayered target appearance on MR images with prominent peripheral rim with high signal intensity (SI) on T1-weighted and very low SI on T2-weighted images, corresponding to thrombosed vascular channels. The above combination of imaging findings is to our knowledge distinct and should suggest the diagnosis of hepatic epithelioid hemangioendothelioma.

Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments: midterm results of doxorubicin-loaded DC bead.

PURPOSE: To examine the results of segmental transcatheter arterial chemoembolization with doxorubicin-loaded DC Bead in the treatment of hepatocellular carcinoma (HCC) in non-surgical candidates. MATERIAL AND METHODS: Seventy-one patients (60% men; 11% women; mean age 63; range 46-71 years) with documented HCC of 3-10 cm in diameter (mean 6.2) were enrolled prospectively in the study. All patients had cirrhosis-related HCC that was developed on an underlying controlled hepatitis infection. Only patients with compensated cirrhosis--Child A or B--were included in this study. RESULTS: Overall complete response (CR) according to EASL on an intention to treat basis was seen in 11 patients who developed complete necrosis (15.5%). Objective response (OR) ranged from 66.2% to 85.5% across the four treatments. Survival at 12 months was 97.05%. Sustained CR was observed in 11 (16.1%), and OR in 49 (72%). Sustained partial response was seen in 49 patients (72.05%). Survival at 18 months was 94.1%. At 24 months follow-up survival was 91.1%. Sustained OR was seen in 45 patients (66.2%) while sustained CR was 16.1% (11/68). At 30 months survival was 88.2%. One patient with CR developed multifocal HCC in areas that most likely were not embolized during the previous embolization sessions. In this patient recurrence-free survival was 28 months. Alpha Fetroprotein levels decreased significantly in measurements 1 month post each procedure (p < 0.001). Bilirubin, gamma-GT, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase (ALP) showed only transient increases observed during the study period. Severe procedure-related complications were seen in 4.2% (cholecystitis: n = 1; liver abscess: n = 1; pleural effusion: n = 1). Post Embolization Syndrome (PES) was observed in all patients. CONCLUSION: Transcatheter arterial chemoembolization with DC Bead is an effective and safe procedure in the treatment of HCC patients not eligible for curative treatments with high rates of response and high rates of mid term survival.

Screening for abdominal aortic aneurysms during routine lumbar CT scan: modification of the standard technique.

INTRODUCTION: Abdominal aortic aneurysms (AAAs) are often incidental findings in patients undergoing US, CT or MRI studies. The recommended field of view (FOV) for standard CT examinations of the spine is 14 cm. This FOV does not allow full visualization of the abdominal aorta. PURPOSE: To justify a larger FOV for male smokers older than 55 years and women older than 65 years, with a higher incidence of AAA. MATERIALS AND METHODS: The lumbar CT examinations of 100 consecutive patients (age: mean 68 years, range 55-85 years) presented with low-back pain were retrospectively reviewed. Measurements of the abdominal aorta and lumbar abnormalities were analysed. A control study in 850 patients who underwent abdominal CT scans for other causes was available for comparison. RESULTS: There were three men with AAAs measuring 4.5, 5.5 and 5.6 cm (mean 5.2 cm). Findings related to the clinical problem were disk prolapse or herniation, spondylosis, spinal stenosis and grade I spondylolesthesis. In the control group, 17 patients were found with AAAs with diameter greater than 4 cm (2%). CONCLUSIONS: Patients with low-back pain, older than 55 years of age, examined with lumbar spine CT, should also be screened for aortic disease, since the prevalence of AAA is similar with that of an age-matched control group. Appropriate modification in the applied FOV is recommended.

Cystic tumors of the pancreas: preoperative imaging, diagnosis, and treatment.

The objective of this retrospective study was to explore the accuracy of preoperative diagnostic methods and the efficacy of treatment for cystic pancreatic tumors. From 1989 to 1999, 18 patients underwent surgery for cystic tumor of the pancreas, classified as follows: one serous cystadenoma, eight mucinous cystadenomas, six mucinous cystadenocarcinomas, and three nonfunctioning islet cell tumors. Computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and fine needle aspiration were performed and subsequently reviewed retrospectively by two radiologists. Three patients underwent the Whipple procedure and 14 and 1 patients underwent distal and central pancreatectomy, respectively. CT showed cystic pancreatic tumors in all cases. One case was misdiagnosed as a pseudocyst. The diagnosis was accurate in 82%, 53%, 37%, and 60% of cases on CT, ERCP, and angiography, and in the cytologic analysis of the aspirated fluid, respectively. All operative procedures were performed without significant morbidity and there were no postoperative deaths. Preoperative diagnosis of cystic pancreatic tumours is imprecise. CT is the most reliable preoperative imaging method. Resection should be the treatment of choice for these lesions, except in cases of serous cystadenoma.