Serial Changes of Tendon Histomorphology and Strain Elastography After Induced Achilles Tendinopathy in Rabbits: An In Vivo Study.

OBJECTIVES: The purpose of this study was to investigate and compare the serial changes of morphology and strain in the early process of Achilles tendinopathy in a rabbit model. METHODS: A total of 10 New Zealand white rabbits underwent ligation of one of their Achilles tendons to induce ischemic injury. Both inflamed and contralateral Achilles tendons were serially evaluated with 3 follow-ups: the first on days 3 to 5, the second on days 9 to 13, and the third and last follow-up on days 15 to 20 after surgery. During each examination, tendon thickness was measured and red, green, and blue pixel intensities of the elastogram were analyzed using color histogram analysis software. Differences between the inflamed and control group were compared. RESULTS: The mean thickness of the inflamed tendons increased during consecutive follow-ups and was significantly larger than that of control tendons (P < .01). The mean red pixel intensity ratio of the inflamed tendons was also serially increased and was higher than that in the control tendons, indicating softening. However, the difference was significant only in the second and third follow-ups (P < .01). CONCLUSIONS: Tendon thickening and softening developed during the early process of Achilles tendinopathy in a rabbit model. Tendon softening may present later than thickening.

Visibility of focal liver lesions: Comparison between kupffer phase of CEUS with sonazoid and hepatobiliary phase of gadoxetic acid-enhanced MRI.

BACKGROUND: To investigate the agreement between Kupffer phase of Sonazoid contrast-enhanced sonography (CEUS) and hepatobiliary phase of gadoxetic acid-enhanced MRI in the evaluation of focal liver lesions (FLLs). METHODS: One hundred fifty-four FLLs in 154 patients who underwent both Sonazoid CEUS and gadoxetic acid-enhanced liver MRI were included in this retrospective study. FLL visibility on the Kupffer-phase images was graded as one (invisible or isoenhancing), two (vaguely visible or vaguely hypoenhancing), or three (clearly visible or clearly hypoenhancing), and that on the hepatobiliary-phase images of MRI was graded as one (invisible or hyper/isointense), two (vaguely visible or weakly hypointense), or three (clearly visible or strongly hypointense). Pairwise comparison of lesion visibility between the two modalities was performed, and intermodality agreement was assessed. RESULTS: On Kupffer-phase CEUS, 31 (20.1%) lesions were invisible, 17 (11.1%) were vaguely visible, and 106 (68.9%) were clearly visible. On the hepatobiliary-phase MRI, 9 (5.9%) lesions were invisible, 45 (29.2%) were vaguely visible, and 100 (64.9%) were clearly visible. Overall, lesion visibility scores were not significantly different between the two modalities (p = 0.121), but the visibility was significantly better on MRI in smaller lesions. Twenty-eight lesions (18.2%) showed discrepancy in the visibility on CEUS and MRI, and most of the cases (89.7%) were lesions that were invisible on CEUS but visible on MRI. CONCLUSIONS: The overall visibility of FLLs was comparable between the Kupffer phase of Sonazoid-CEUS and the hepatobiliary-phase images of gadoxetic acid-enhanced MRI, with a discrepancy between the two modalities in 18% of the cases. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:542-550, 2017.

Real-time contrast-enhanced sonographically guided biopsy or radiofrequency ablation of focal liver lesions using perflurobutane microbubbles (sonazoid): value of Kupffer-phase imaging.

OBJECTIVES: To evaluate the utility of Kupffer-phase imaging by real-time contrast-enhanced sonography using the perflurobutane microbubble contrast agent Sonazoid (GE Healthcare, Oslo, Norway) in guiding biopsy or radiofrequency (RF) ablation of focal liver lesions. METHODS: A total of 75 patients (mean age, 59.7 years) who were referred for percutaneous biopsy (n = 42) or RF ablation (n = 33) were included in the study. Grayscale sonography and contrast-enhanced sonography using Sonazoid were performed in all patients before the procedure. The conspicuity of each targeted liver lesion on grayscale sonography, vascular-phase contrast-enhanced sonography, and Kupffer-phase contrast-enhanced sonography was graded using a 5-point scale. Lesion detection rates were calculated, and the conspicuity of the lesions among the imaging modalities was compared. The technical success of the procedures was also assessed. RESULTS: The procedures were conducted in 66 patients (biopsy in 41 and RF ablation in 25) under real-time guidance by Kupffer-phase contrast-enhanced sonography. Lesion detection rates were 77.3% (58 of 75), 84.0% (63 of 75), and 92.0% (69 of 75) on grayscale sonography, vascular-phase contrast-enhanced sonography, and Kupffer-phase contrast-enhanced sonography, respectively, and were significantly different among the 3 modalities (P= .034). Overall, lesion conspicuity was significantly increased on vascular-phase and Kupffer-phase contrast-enhanced sonography compared to grayscale sonography (P < .001). Technical success rates for the procedures were 95.2% (40 of 42) for biopsy and 69.7% (23 of 33) for RF ablation. CONCLUSIONS: Kupffer-phase imaging by contrast-enhanced sonography using Sonazoid increases the conspicuity of the liver lesions compared to grayscale sonography, and it is useful for real-time guidance of percutaneous biopsy or RF ablation of focal liver lesions.

Diagnosis of esophageal varices on liver CT: is thin-section reconstruction necessary?

BACKGROUND/AIMS: The aim of this study was to evaluate the effect of 1 mm, 3 mm, and 5 mm section thicknesses of liver CT on the detection and grading of esophageal varices in cirrhotic patients. METHODOLOGY: A total of 219 consecutive cirrhotic patients who had undergone both upper endoscopy and 64-channel liver CT were included. Portal phase images of each CT were reconstructed with a section thickness of 1 mm, 3 mm, and 5 mm. Four radiologists independently reviewed the 3 image sets. The observers evaluated the presence of esophageal varices on a 5-point confidence scale and measured the maximal short diameter of the largest varix identified. Sensitivity, specificity and predictive value calculation and receiver operating characteristic analysis were performed. Correlation between CT measurements and endoscopic grading as the reference standard was assessed. RESULTS: The averaged Az values at 1 mm, 3 mm, and 5 mm image sets were 0.936, 0.946, and 0.935, respectively, and they were not significantly different among the 4 observers. When a 3 mm cut-off criterion for large varices was applied, sensitivity, specificity, and predictive values were comparable among the 3 image datasets. CONCLUSIONS: Routine liver CT protocol is sufficient for evaluation of esophageal varices in cirrhotic patients without adding thin section reconstruction images.

Unenhanced CT for the detection of renal cell carcinoma: effect of tumor size and contour type.

PURPOSE: To evaluate effect of tumor size and contour type for the detection of renal cell carcinoma (RCC) on unenhanced CT. METHODS: This retrospective institutional review board approved study that includes 111 patients with RCC and 100 patients without RCC who underwent unenhanced CT. Two readers performed a blinded and independent review of the presence of RCC on unenhanced CT. The area under the receiver operating characteristic curves (AUC) was compared by tumor size (<3 cm: small, or ≥3 cm: large) and contour type (endophytic, mesophytic, or exophytic). RESULTS: For tumor size, the AUC for small RCC (0.70 and 0.78, for reader 1 and reader 2) was significantly lower than that for large RCC (0.97 and 0.99, for reader 1 and reader 2) (p < 0.001). As for contour type of tumor, the AUC for endophytic RCC (0.60 and 0.71, for reader 1 and reader 2) was significantly lower than that for mesophytic RCC (0.95 and 0.98, for reader 1 and reader 2) and exophytic RCC (0.98 and 0.99, reader 1 and reader 2) (p < 0.001). CONCLUSION: On unenhanced CT, tumor size and contour type can affect the detection of RCC. While most large or exophytic RCC can be easily detected, the detection of small and endophytic RCC is highly limited.

Assessment of global left ventricular function with dual-source computed tomography in patients with valvular heart disease.

BACKGROUND: Left ventricular (LV) function is a vital parameter for prognosis, therapy guidance, and follow-up of cardiovascular disease. Dual-source computed tomography (DSCT) provides an accurate analysis of global LV function. PURPOSE: To assess the performance of DSCT in the determination of global LV functional parameters in comparison with cardiovascular magnetic resonance (CMR) and two-dimensional transthoracic echocardiography (2D-TTE) in patients with valvular heart disease (VHD). MATERIAL AND METHODS: A total of 111 patients (58 men, mean age 49.9 years) with known VHD and who underwent DSCT, 2D-TTE, and CMR a period of 2 weeks before undergoing valve surgery were included in this study. LV end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV), and ejection fraction (EF) were calculated by DSCT using the threshold-based technique, by 2D-TTE using a modified Simpson's method, and by CMR using Simpson's method. Agreement for parameters of LV global function was determined with the Pearson's correlation coefficient (r) and Bland-Altman analysis. All the DSCT and CMR data-sets were assessed independently by two readers. RESULTS: Fifty of the total 111 patients had aortic VHD, 29 patients had mitral VHD, and 32 patients had mixed aortic and mitral VHD. An excellent inter-observer agreement was seen for the assessment of global LV function using DSCT (r = 0.910-0.983) and CMR (r = 0.854-0.965). An excellent or good correlation (r = 0.93, 0.95, 0.87, and 0.71, respectively, P < 0.001) was noted between the DSCT and 2D-TTE values for EDV, ESV, SV, and EF. EDV (33.7 mL, P < 0.001), ESV (12.1 mL, P < 0.001), SV (21.2 mL, P < 0.001), and EF (1.6%, P = 0.019) were significantly overestimated by DSCT when compared with 2D-TTE. An excellent correlation (r = 0.96, 0.97, 0.91, and 0.94, respectively, P < 0.001) between DSCT and CMR was seen in the evaluation of EDV, ESV, SV, and EF. EDV (15.9 mL, P < 0.001), ESV (7.3 mL, P < 0.001), and SV (8.5 mL, P < 0.001) were significantly underestimated, but EF (1.1%, P = 0.002) was significantly overestimated by DSCT when compared with CMR. CONCLUSION: Our study showed that DSCT measurements of global LV function using the threshold-based technique were highly reproducible and compared more favorably with CMR measurements using Simpson's method than those of 2D-TTE using the modified Simpson's method. DSCT enables accurate quantification of global LV function in patients with VHD.

Benign regional lymph nodes in gastric cancer on multidetector row CT.

BACKGROUND: Benign regional lymph nodes (LNs) are sometimes enlarged in gastric cancer patients due to reactive or inflammatory changes. Frequently these enlarged LNs can mimic LN metastasis and lead to overstaging. PURPOSE: To assess frequency of benign regional LNs in gastric cancer patients compared with that in a healthy population and to assess the frequency of benign regional LNs in gastric cancer according to T-staging. MATERIAL AND METHODS: Between August 2005 and June 2009, 177 patients with surgically proven gastric cancer without LN metastasis (TanyN0M0) who had previously undergone preoperative multidetector row CT (MDCT) and 168 healthy patients who visited the healthcare center and underwent an abdominal MDCT were included in this retrospective study. An abdominal radiologist evaluated the distribution of regional LNs and measured the short diameter of LNs ≥6 mm, ≥8 mm, and ≥10 mm. The number of enlarged benign LNs was compared between the two groups, and the distribution of LN with regard to T-stage of gastric cancer was also evaluated. RESULTS: At least one LN ≥6 mm, ≥8 mm, and ≥10 mm was detected in 64.4% (114/177), 22.0% (39/177), and 4.0% (7/177) of patients in the gastric cancer group, respectively, compared to 29.8% (50/168), 4.2% (7/168), and 0% of patients in the healthy group, respectively. The difference between the two groups was statistically significant (P <0.0001). The LN ≥8 mm was found in 14.9% (20/134) in early gastric cancer (T1), and 44.2% (19/43) in advanced cancer (T2 or higher); the difference was statistically significant (P = 0.0002). However, the frequency of LN ≥6 mm in mucosal cancer (T1a) and submucosal cancer (T2b) was not significantly different, regardless of its size. CONCLUSION: Benign regional LNs ≥6 mm are more frequently detected in gastric cancer patients than in a healthy population and in advanced gastric cancer than in early cancer.

Diffuse gallbladder wall thickening on computed tomography in patients with liver cirrhosis: correlation with clinical and laboratory variables.

OBJECTIVES: The objective of the study was to retrospectively evaluate (a) which clinical/laboratory features are associated with the presence of diffuse gallbladder wall thickening (DGWT) in cirrhotic patients and (b) whether the degree of DGWT is correlated with such clinical/laboratory variables. METHODS: After excluding patients with DGWT or laboratory test abnormalities from known causes unrelated to liver cirrhosis, a retrospective review of liver computed tomography obtained from 242 consecutive cirrhotic patients was performed by 2 radiologists in consensus to determine the presence of DGWT of greater than 3 mm in thickness and, if present, to measure the degree of DGWT defined as maximal thickness. Univariate and multivariate analysis were performed to evaluate association between presence/degree of DGWT and clinical/laboratory features. RESULTS: Of 242 patients, 73 (30.2%) had DGWT. Diffuse gallbladder wall thickening was seen in 7.6% (12/157) of patients with Child-Pugh class A, 61.1% (33/54) of class B, and 90.3% (28/31) of class C (P < 0.001). The presence of ascites, lower platelet count, and lower albumin level were independently associated with the presence of DGWT (P < 0.01, P = 0.01, and P = 0.02, respectively). However, these factors did not show significant correlation with the degree of DGWT. CONCLUSIONS: The presence of DGWT in cirrhotic patients is associated with the presence of ascites, lower platelet count, and lower albumin level. The degree of DGWT is not correlated with such variables.

Acute pelvic inflammatory disease: diagnostic performance of CT.

AIM: To evaluate retrospectively the performance of computed tomography (CT) for the diagnosis of acute pelvic inflammatory disease (PID) by the use of clinical and laboratory data as the reference standard. METHODS: The study was approved by the institutional review board. A total of 190 women of reproductive age (age range, 16-49 years; mean age, 29.3 ± 7.6 years) with complaints of non-traumatic acute lower abdominal pain underwent subsequent abdominopelvic CT. The diagnosis of acute PID was confirmed by the clinical and laboratory findings. Two radiologists performed a blinded, independent, retrospective review of the CT findings of acute PID. Discordant findings were resolved by a consensus review with a third radiologist. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each CT finding for the diagnosis of acute PID were determined. Kappa statistics were used to estimate agreement between readers. RESULTS: Pelvic inflammatory disease was present in 48 (25.3%) of the 190 patients. The most specific CT finding for the diagnosis of acute PID was tubal thickening of both fallopian tubes (95.1%). The most sensitive CT finding was mid-pelvic fat stranding (60.4%). CONCLUSION: The CT finding of tubal thickening is highly specific for the diagnosis of acute PID, although overall CT sensitivity is poor.

Targeted sonography for small hepatocellular carcinoma discovered by CT or MRI: factors affecting sonographic detection.

OBJECTIVE: The purpose of this study was to evaluate the detection rate of targeted sonography for small (

Deep infiltrating endometriosis: CT imaging evaluation.

OBJECTIVE: To retrospectively evaluate the feasibility of computed tomography (CT) in depicting deep-infiltrating endometriosis. MATERIALS: The study population included 54 patients (age: mean, 35.5 years; range, 23-48 years) with histologically confirmed ovarian endometriomas between January 2007 and July 2009. All the patients underwent preoperative CT imaging before laparotomy or laparoscopy. The CT images were evaluated for the presence of a tethered appearance of the rectum in the direction of the uterus, stranding of periuterine pelvic fat, thickening of the uterosacral ligament, and retroflexed uterus. Two radiologists performed a blinded and independent review for each CT finding. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of each CT finding and kappa statistics were determined. RESULTS: Deep-infiltrating endometriosis was confirmed after surgery and pathologic examination in 34 patients (63.0%). The most specific finding for the diagnosis of deep-infiltrating endometriosis was tethered appearance of rectum in the direction of the uterus (90.0%). The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values of all the CT findings except that of retroflexed uterus were 56.9%, 70.0%, 78.1%, 60.4%, and 61.7%, respectively. The mean kappa value was 0.82 (range, 0.67-0.96). CONCLUSIONS: Computed tomographic imaging may constitute another potential option as a complementary imaging modality for the evaluation of deep-infiltrating endometriosis.

Sensitivity of digital abdominal radiography for the detection of ureter stones by stone size and location.

OBJECTIVE: To assess the sensitivity of digital abdominal radiography in the detection of ureteral stones by stone size and location. MATERIALS AND METHODS: We retrospectively reviewed the digital abdominal radiography of 163 patients for the detection of ureteral stones. Each ureteral stone was confirmed by unenhanced computed tomography (CT) in the emergency department between January and December, 2009. Stone location was defined as proximal or distal by the level where the ureter crossed anterior to iliac vessels, and the stone size was defined as small if smaller than 5 mm and large if larger than 5 mm on unenhanced CT. The interpretation of digital abdominal radiography was classified as visible, invisible, or equivocal. RESULTS: In 163 ureteral stones, 77 stones (47.2%) were in the proximal ureter and 86 stones (52.8%) were in the distal ureter. The mean (SD) size of the ureteral stones was 3.4 (1.7) mm (range, 1-9 mm). Overall sensitivity of digital radiography for ureteral stones was 29.4%. The sensitivity of digital radiography for the proximal ureteral stones was 37.7% and that for the distal ureteral stones was 22.1% (P < 0.05). The sensitivity of digital radiography for small ureteral stones was 23.6% and that for large ureteral stones was 50.0% (P < 0.05). As a group, the sensitivity of digital radiography for large proximal ureteral stones was the highest sensitivity-72.2%-in all groups (P < 0.05). CONCLUSION: Digital abdominal radiography is useful in detecting large proximal ureteral stones.

Sequential changes in echogenicity and conspicuity of small hepatocellular carcinoma on gray scale sonography after transcatheter arterial chemoembolization.

OBJECTIVE: The purpose of this study was to assess sequential changes in the echogenicity and conspicuity of small hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). METHODS: Seventy patients with nodular HCC underwent 3 serial abdominal sonographic examinations before (t0), immediately after (t1), and 2 to 4 days after (t2) TACE. The echogenicity and conspicuity of the HCC nodules were prospectively graded using a 5-point scale. For all tumors, any changes in the echogenicity and conspicuity scores obtained at t0, t1, and t2 were evaluated. The degree of intratumoral uptake of iodized oil was categorized as compact or noncompact based on unenhanced computed tomographic images. Within each group, the sequential changes in the echogenicity and conspicuity were analyzed. Cross-sectional comparisons of the echogenicity and conspicuity at each time point between the two groups were also made. RESULTS: Overall, the lesion echogenicity and conspicuity at t1 increased compared with those at t0 (P < .05). Thereafter, both the echogenicity and conspicuity at t2 decreased compared with those at t1 (P < .05). There were 41 HCC nodules with compact iodized oil uptake and 29 with noncompact uptake. Significant sequential changes in the echogenicity (increase at t1 followed by decrease at t2) were noted in both groups, but only the compact group showed a significant change in conspicuity. In a cross-sectional comparison, the compact group showed higher scores for both echogenicity and conspicuity than the noncompact group at both t1 and t2 (P < .05). CONCLUSIONS: The echogenicity and conspicuity of HCC are increased immediately after TACE. These effects are significantly diminished 2 to 4 days after TACE.

Value of Fluoroscopic Defecography in Constipated Children With Abnormal Colon Transit Time Test Results.

BACKGROUND/AIMS: Colon transit time (CTT) test is regarded as the gold standard for evaluating colon transit function. Fluoroscopic defecography (FD) is a dynamic radiologic test to assess anorectal function. The aim is to evaluate the value of FD in constipated children with abnormal CTT test results. METHODS: Fifty-one children (27 girls) with a mean age of 9.8 ± 3.2 years who met Rome III criteria for constipation and older than 5 years with abnormal CTT test results underwent FD. RESULTS: Of 51 children, 27 (52.9%) showed positive findings on FD, including pelvic floor dyssynergia (PFD) (10/27, 37.0%), structural abnormality (15/27, 55.6%) (rectocele 53.3%, intussusception 33.3%, and both 13.4%), and both PFD and rectocele (2/27, 7.4%). In terms of CTT test subtype, of 35 children who had outlet obstruction type in CTT test, 19 (54.2%) had positive findings, including PFD (8/19, 42.1%), structural abnormality (9/19, 47.4%) (rectocele 55.6%, intussusception 22.2%, and both 22.2%), and both PFD and rectocele (2/19, 10.5%). Of the 16 children who had slow transit type of CTT test, 8 (50.0%) had positive findings, including PFD (2/8, 25.0%) and structural abnormality (6/8, 75.0%). Of the 6 children who had structural abnormality, 3 (50.0%) had rectocele and 3 (50.0%) had intussusception. For the 2 children (2/16, 12.5%) who had PFD, puborectalis muscle relax failure was found on FD. Puborectalis muscle relax failure was treated with biofeedback and medication. In the minor abnormalities, medication continued without additional therapeutic modalities. CONCLUSIONS: FD was valuable for both diagnoses of underlying causes and interpretation of CTT test results in children with abnormal CTT test results. Therefore, this study suggests that FD and CTT tests should be incorporated into logical thinking for constipation in children.

Risk Factors for Liver Function Deterioration after Transarterial Chemoembolization Refractoriness in Child-Pugh Class A Hepatocellular Carcinoma Patients.

Background/Aims: A switch to systemic therapy, such as sorafenib, should be considered for hepatocellular carcinoma (HCC) patients refractory to transarterial chemoembolization (TACE). On the other hand, treatment changes are difficult if the liver function worsens to Child-Pugh B or C. Therefore, predicting the risk factors for non-responsiveness to TACE and deteriorating liver function may be helpful. Methods: Newly diagnosed Child-Pugh A HCC patients who underwent TACE from January 2012 to June 2018 were included. After 1 year, this study evaluated whether there was a treatment response to TACE and whether the Child-Pugh class had worsened. Results: Among 121 patients, 65 were refractory and 56 responded to TACE. In multivariable logistic regression analysis, the tumor size, tumor number, and albumin at the time of the diagnosis of HCC were significant prognostic factors for the treatment response to TACE. Among 65 patients who presented TACE-refractoriness, 27 showed liver function deterioration from Child-Pugh class A to class B or C after TACE. In multivariable logistic regression analysis, bilirubin at the diagnosis of HCC was a significant prognostic factor for liver function deterioration. A predictive algorithm based on the regression equations revealed a sensitivity, specificity, positive predictive value, and negative predictive value of 74.1%, 74.5%, 45.5%, and 90.9%, respectively, for TACE-refractoriness and liver function deterioration. Conclusions: The prognostic model incorporating the tumor size, tumor number, albumin, and bilirubin at the diagnosis of HCC may help identify patients who show a poor response to TACE and aggravation of liver function after TACE, who may benefit from early switching into systemic therapy before liver function aggravation.

Sonography of acute right lower quadrant pain: importance of increased intraabdominal fat echo.

OBJECTIVE: The purpose of our study was to assess the diagnostic usefulness of increased intraabdominal fat echo during the sonographic evaluation of patients with acute right lower quadrant (RLQ) pain. SUBJECTS AND METHODS: A total of 328 consecutive patients (132 male and 196 female; mean age, 28+/-15 [SD] years) with acute RLQ pain prospectively underwent transabdominal sonography by one of three experienced radiologists. The radiologists prospectively graded intraabdominal fat echo using a 3-point scale: 1, normal; 2, slight increase; and 3, marked and diffuse increase. Final diagnoses were made using surgical or pathologic findings or by clinical follow-up. Of the 328 patients, 11 were lost to follow-up and excluded from analysis. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of increased intraabdominal fat echo were calculated for a positive final diagnosis. RESULTS: Final diagnoses were negative (n=103), acute appendicitis (n=137), right colonic diverticulitis (n=18), mesenteric lymphadenitis (n=13), enteritis (n=26), and others (n=20). Grades of intraabdominal fat echo were grade 1 (n=158), grade 2 (n=35), and grade 3 (n=124). Overall, fat echo grades 2 or 3 were more frequently observed in patients with a positive final diagnosis (73% [157/214] vs 2% [2/103], p<0.001) than in those with a negative final diagnosis. Sensitivity, specificity, accuracy, PPV, and NPV of increased intraabdominal fat echo for a positive final diagnosis were 73%, 98%, 81%, 99%, and 64%. Increased intraabdominal fat echo was documented in 89% (122/137) of cases of acute appendicitis and in 100% (18/18) of cases of right colonic diverticulitis. CONCLUSION: An increased intraabdominal fat echo on sonography is highly specific for the presence of RLQ inflammatory disease.

Shrinkage of hepatocellular carcinoma after radiofrequency ablation following transcatheter arterial chemoembolization: Analysis of contributing factors.

OBJECTIVE: This study was conducted to investigate tumor shrinkage and influencing factors in patients with hepatocellular carcinoma (HCC) from radiofrequency (RF) ablation following transcatheter arterial chemoembolization (TACE). METHODS: A total of 222 patients underwent combined sequential treatment of TACE and RF ablation for HCC at our institution between 2008 and 2014. Of those, 86 patients (men, 68; women, 18) who achieved compact iodized oil tagging and complete ablation were included for this retrospective study. We measured three-dimensional tumor diameters and calculated tumor volumes on pre-treatment CT/MRI and follow-up CT scans performed post-TACE, post-ablation, and 1 month post-treatment, respectively. To compare periodically generated tumor diameters and volumes, repeated measures analysis of variance (ANOVA) was applied. Multiple linear regression analysis was performed to identify factors impacting tumor shrinkage after RF ablation. RESULTS: Diameters and volumes of HCCs declined significantly in the immediate aftermath of RF ablation (i.e., between post-TACE and post-ablation CT scans) (p < 0.001, for both). Mean reduction rates in tumor diameter and volume immediately after RF ablation were 18.2 ± 9.1% and 44.4 ± 14.6%, respectively. Of note, tumors of left hepatic lobe and in subphrenic or perivascular locations showed lower rates of post-ablative volume reduction than those in counterpart locations (p = 0.002, 0.046, 0.024, respectively). Tumor size and liver function did not influence tumor shrinkage after RF ablation. CONCLUSION: In patients with HCC, significant tumor shrinkage occurs immediately after RF ablation. The degree of shrinkage in response to ablative treatment seems to vary by tumor location.

Efficacy and Safety of Combined Radiofrequency Ablation with Transarterial Chemoembolization in Patients with Barcelona Clinic Liver Cancer Stage A Hepatocellular Carcinoma Ineligible for Curative Treatment.

Background/Aims: Surgical resection or ablation is recommended for the treatment of early hepatocellular carcinoma (HCC), whereas transarterial chemoembolization (TACE) is frequently used in early HCC ineligible for curative resection. We evaluated the clinical effects and safety of radiofrequency ablation (RFA) shortly after TACE in patients with Barcelona clinic liver cancer (BCLC) stage A HCC. Methods: Sixty-seven BCLC stage A HCC patients who failed to achieve complete response to TACE as either a first line treatment and who subsequently received RFA at the Konkuk University Medical Center from January 2005 to December 2017 were included. Evaluation indices included treatment response, overall survival rate, recurrence-free survival, prognostic factors, and procedure-related complications. Results: Median follow-up was 46.9 months. Fifty-four (80.6%) patients were of Child-Pugh class A, and 13 (19.4%) were of class B. Modified UICC stages were I in 10 (14.9%), II in 46 (68.7%), and III in 11 (16.4%) patients. In the 67 study subjects, cumulative recurrence-free survival rates were 86.8%, 55.9% and 29.7% at 1, 3, and 5 years, respectively, and overall survival rates were 100%, 93.4%, and 83.5% at 1, 3, and 5 years, respectively. Tumor size significantly predicted recurrence. No treatment-related death occurred. Conclusions: Combination of RFA was an efficient and safe treatment for BCLC stage A HCC patients that failed to achieve complete response to initial TACE. We suggest TACE plus RFA be considered as a curative option for early HCC patients ineligible for curative resection of RFA.

Struma ovarii: CT findings.

BACKGROUND: The purpose of this study was to evaluate computed tomographic findings of struma ovarii. METHODS: Computed tomography (CT) scans of 13 pathologically proven struma ovarii were retrospectively reviewed by two radiologists in consensus. Scans were evaluated for the laterality, size, mass configuration, margins, internal architecture, presence of intracystic high attenuation lesions on precontrast scans, and cyst wall enhancement. RESULTS: The mean size of the tumors was 11.4 cm (range 4.7-21.0 cm). Mainly cystic (n = 8, 61.5%) or cystic (n = 5, 38.5%) appearance was common to all the tumors. All tumors were unilateral and had smooth margins. The most common internal architecture in the tumors was multicystic architecture (n = 11, 84.6%). Eleven tumors (84.6%) showed a high attenuation lesion in the cyst portion of the mass on precontrast scans and the attenuation ranged from 92.2 to 120.5 Hounsfield units (HU) (mean, 106.8 +/- 8.8 HU). The cyst wall showed no (n = 7, 53.8%), moderate (n = 5, 38.5%), or marked (n = 1, 7.7%) enhancement after administration of contrast medium. CONCLUSIONS: On CT scans, struma ovarii appeared most often as a smooth marginated multicystic mass with a high attenuation lesion on precontrast scans and no or moderate cyst wall enhancement.