RESUMO
A 67-year-old man was treated for diabetes mellitus by his family doctor. A splenic tumor was suspected based on his pain in the left side of the abdomen. He was admitted to our hospital for close inspection and medical treatment. Abdominal CT and MRI scans showed a tumor, 10 cm in diameter, in the spleen. An opaque boundary with the diaphragm was also observed. On PET-CT, accumulations of FDG were observed in the left supraclavicular fossa and the left axilla. The serum levels of LDH and sIL-2R were elevated, and therefore a diagnosis of malignant lymphoma was suspected. Due to the risk of splenic rupture, a splenectomy was performed. After pathological examination, the patient was diagnosed with diffuse large B-cell malignant lymphoma. He is currently being treated with chemotherapy at another medical institute. Splenic rupture occurs in some cases of splenic malignant lymphoma, although the number of reported cases is low. In some of the cases, splenic rupture occurred during treatment of the malignant lymphoma. There is no specific way to measure the risk of splenic rupture; however, performing a prophylactic splenectomy is one option in cases where tumor cells have extended to the capsula lienis, similar to that in our patient.
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Linfoma Difuso de Grandes Células B/diagnóstico , Esplenectomia , Neoplasias Esplênicas/patologia , Idoso , Diafragma/patologia , Humanos , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Invasividade Neoplásica , Ruptura Espontânea/prevenção & controle , Neoplasias Esplênicas/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND Chronic mesenteric ischemia (CMI) is defined as ischemic symptoms caused by insufficient supply of blood to the gastrointestinal tract. Patients diagnosed with advanced symptomatic CMI should be treated subsequently, as the transition from CMI to acute mesenteric ischemia can be unpredictable. However, there is little information regarding the management of potential procedural complications during endovascular therapy (EVT) for CMI. CASE REPORT A 70-year-old man was admitted to our hospital with recurrent abdominal pain just after hemodialysis. The angiogram showed significant stenosis with heavy calcification in the proximal of the superior mesenteric artery (SMA), leading to the diagnosis of CMI. To alleviate the symptom, EVT for the stenotic lesion of the SMA was indicated. During the procedure, a cutting balloon was inflated to facilitate vessel expansion in the target lesion. As a result, intravascular ultrasound (IVUS) imaging revealed dissection into the media with extension into the medial space without reentry and demonstrated a semilunar intramural hematoma. We were able to contain the intramural hematoma by covering the whole dissection in the SMA with implantation of self-expandable stents. CONCLUSIONS This case highlights the potential of EVT for heavy calcification of the SMA complicated by dissection without reentry. Intramural hematoma was observed with IVUS examination. We were able to contain the hematoma by the implantation of self-expandable stents over the whole length of the SMA dissection under IVUS-guided EVT.
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Isquemia Mesentérica , Oclusão Vascular Mesentérica , Masculino , Humanos , Idoso , Artéria Mesentérica Superior/diagnóstico por imagem , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/terapia , Intestinos , Ultrassonografia , Doença Crônica , Isquemia , Stents , Resultado do TratamentoRESUMO
Cystic neoplasms arising from the prostate are rare, and stromal tumours of uncertain malignant potential and the spectrum of cystic epithelial tumours of the prostate are the major differential diagnoses of a cystic prostatic neoplasm. We report a case of a stromal tumour of uncertain malignant potential, which showed a multilocular cystic mass with some solid components. The solid component of the tumour did not show substantial diffusion restriction and uptake of 18F-FDG-PET, and this could be the critical finding suggesting a stromal tumour of uncertain malignant potential rather than a malignant cystic epithelial tumour.
RESUMO
The usefulness of whole-body 18-fluoro-2-deoxyglucose (FDG)-fluorodeoxyglucose positron emission (PET)/computed tomography (CT) is established for assessment of disease staging, detection of early disease recurrence, therapeutic evaluation, and predicting prognosis in various malignancies; and for evaluating the spread of inflammation. However, the role of FDG-PET/CT for the liver is limited because CT and magnetic resonance imaging (MRI) can provide an accurate diagnosis of most tumors. In addition, in other potentially useful roles there are several pitfalls in the interpretation of FDG uptake in PET/CT imaging. Accurate evaluation demands knowledge of the FDG uptake of each lesion, including potential negative and positive uptakes, and requires an understanding of the underlying background of the molecular mechanisms. The degree of FDG uptake is dependent on cellular metabolic rate and the expression of glucose transporter, hexokinase, and glucose-6-phosphatase, which in turn are closely affected by biological characteristics such as pathological category (e.g., adenocarcinoma, squamous cell carcinoma, small cell cancer, transitional cell cancer, neuroendocrine tumor, sarcoma, lymphoma), tumor differentiation, histological behavior (e.g., solid, cystic, mucinous), and intratumoral alterations (e.g., necrosis, degeneration, hemorrhage). Correlation with the CT and MRI findings, which also precisely depict the pathological findings, is important to avoid misdiagnosis.
Assuntos
Fluordesoxiglucose F18 , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
We aimed to evaluate the imaging findings of hepatic metastases from pancreatic cancers, especially wedge-shaped enhancement and its etiology. Dynamic CT and MR images were performed in 87 patients with liver metastases from pancreatic carcinomas, and CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) in 51 patients. Liver metastases were multiple in 84 patients (97%) and solitary in only three (3%). In 44 of 87 patients (51%), all liver metastases showed ring-like enhancement compatible with metastatic adenocarcinomas on dynamic CT and/or dynamic MR imaging. In 37 patients, more than one metastatic lesion showed wedge-shaped contrast enhancement on dynamic CT, dynamic MRI and CTHA, and wedge-shaped perfusion defect on CTAP adjacent to metastatic tumors. Six patients showed multiple wedge-shaped enhancements, which were initially diagnosed as multiple arterioportal shunts (AP shunts). However, metastatic tumors appeared within the area of wedge-shaped enhancement and increased in size on follow-up CT and/or MR images. After all, 43 of 87 patients (49%) had AP shunt like contrast enhancement adjacent to liver metastases. Liver metastases from pancreatic carcinomas frequently show transient wedge-shaped enhancement, and should not be misdiagnosed as nontumorous arterioportal shunts.
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Neoplasias Hepáticas/secundário , Neoplasias Pancreáticas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico por imagem , Sistema Porta/diagnóstico por imagem , Sistema Porta/patologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: To review various portosystemic shunts (PS) and to evaluate their prevalence by CT during arterial portography (CTAP) using a multidetector-row CT (MDCT). METHODS: CTAP of 116 patients (liver cirrhosis 70 patients, non-liver cirrhosis 46 patients) was retrospectively reviewed. CTAP was performed with the catheter placed in the superior mesenteric artery using MDCT. Axial CT images of 0.625- and 3.75- or 2.5-mm thickness were obtained. Multiplanar reformation images and maximum intensity projection images were subjected to review. RESULTS: A part of the veins in the ileocecal region drained into the right renal vein or the inferior vena cava (IVC) via the right gonadal vein in 57 patients (81%). A part of the veins of the ascending colon drained via the right renal capsular vein into the IVC in 37 patients (53%). In 46 patients without liver cirrhosis, the right gonadal and right renal capsular veins were opacified on CTAP in 22 patients (48%) and 20 patients (43%), respectively. CONCLUSIONS: Portosystemic shunts in retroperitoneum were frequently recognized on CTAP images in patients with liver cirrhosis. The right gonadal vein and the right renal capsular vein were the most frequent routes of the portosystemic shunts. They may exist in physiological condition.
Assuntos
Cirrose Hepática/complicações , Fígado/irrigação sanguínea , Portografia/métodos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Fígado/diagnóstico por imagem , Cirrose Hepática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Prevalência , Estudos RetrospectivosRESUMO
In Japan, there are approximately 32 000 deaths ( approximately 30 deaths per 100 000) per year due to hepatocellular carcinoma (HCC), and it is the third most common cancer in men and fifth in women. Approximately 90% of them are associated with chronic liver diseases due to hepatitis C or B virus infection. Therefore, it has become possible to detect small early stage HCC by the periodic screening in these high-risk patients group. During the screening imaging diagnosis of HCC, various kinds of hepatocellular nodules are also frequentlydetected. To characterize them is very important for the early diagnosis and treatment of HCC. For this purpose, it is necessary to understand the concept of multistep hepatocarcinogenesis and the sequential changes of imaging findings.
RESUMO
OBJECTIVES: This study was designed to evaluate the efficacy and feasibility of our intra-arterial chemotherapy protocol with a lower amount and frequency of cisplatin delivery than in RADPLAT for the treatment of resectable advanced head and neck cancer. METHODS: Fifty-one patients with advanced squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx were included in this prospective study. The patients were treated with 3 courses of cisplatin (100 mg at 1 treatment, intra-arterial) and sodium thiosulfate (28 g at 1 treatment, intravenous) once every 2 weeks during concurrent radiotherapy (66 to 70 Gy, 2 Gy per fraction, daily for 5 days over 7 weeks). Nodal metastases larger than 3 cm in diameter were treated with an additional 50 mg of cisplatin. The patients with less than 50% tumor reduction after 40 Gy and 2 courses of chemotherapy were treated with surgery. RESULTS: The protocol was completed for 49 patients. All living patients had a minimum follow-up period of 2 years. Including the 3 patients with salvage surgery, local disease-free control was achieved in 39 patients (80%). For 36 patients (73.5%), disease-free primary organs were preserved at 2 years after treatment. Locoregional disease-free control for 2 years was obtained for 38 patients (77.6%), in 30 of them without salvage surgery. The patients treated with surgery had an overall survival rate similar to that of the patients with a complete response (80% and 84.6%, respectively). The patients with a partial response had a worse prognosis (40%; p = .0069). CONCLUSIONS: This treatment regimen is feasible and effective for advanced resectable head and neck cancer.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Antioxidantes/administração & dosagem , Carcinoma de Células Escamosas/patologia , Cisplatino/administração & dosagem , Intervalo Livre de Doença , Relação Dose-Resposta à Radiação , Estudos de Viabilidade , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Infusões Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tiossulfatos , Resultado do TratamentoRESUMO
Primary extranodal Hodgkin lymphoma (HL) is very rare. We report the first case of primary renal Hodgkin lymphoma and with the absence of supra- and sub-diaphragmatic adenopathy.
RESUMO
OBJECTIVE: This immunohistochemical study aimed to elucidate the molecular mechanism underlying the increased fluorine-18 fludeoxyglucose (FDG) uptake in hepatocyte nuclear factor 1α (HNF1α)-inactivated hepatocellular adenomas (H-HCAs). METHODS: Three resected H-HCAs were studied using FDG positron emission tomography. Each maximum standardized uptake value (SUVmax) was determined. Resected samples were subjected to immunohistochemical staining for the following glucose metabolism-related proteins: glucose transporter 1 (GLUT1) and glucose transporter 2 (GLUT2), indicative of uptake and transport of glucose into cellular cytoplasm; hexokinase 2 (HK2) and hexokinase 4 (HK4), glucose phosphorylation; glucose-6-phosphate transporter 1 (G6PT1), uptake and transport of glucose-6-phosphate into endoplasmic reticulum; and glucose-6-phosphatase (G6Pase), dephosphorylation. RESULTS: All three H-HCAs exhibited increased FDG intake, with an average SUVmax of 6.6 (range: 5.2-8.2). No sample expressed GLUT1 and HK2; all the samples exhibited equivalent GLUT2 and HK4 expression, equivalent or slightly increased G6Pase expression and significantly decreased G6PT1 expression relative to the non-neoplastic hepatocytes of background liver. CONCLUSION: The increased FDG uptake observed in H-HCAs is associated with GLUT2 and HK4 expression and G6PT1 inactivation. ADVANCES IN KNOWLEDGE: H-HCA exhibits a high FDG uptake owing to the inactivation of G6PT1, which is transcriptionally regulated by HNF1α.
Assuntos
Adenoma de Células Hepáticas/metabolismo , Antiporters/metabolismo , Fluordesoxiglucose F18/farmacocinética , Fator 1-alfa Nuclear de Hepatócito/metabolismo , Neoplasias Hepáticas/metabolismo , Proteínas de Transporte de Monossacarídeos/metabolismo , Tomografia por Emissão de Pósitrons , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos/farmacocinética , Estudos RetrospectivosRESUMO
CONTEXT: Adrenal vein sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism (PA), but accurate placement of the sampling catheter is technically challenging. Intraprocedural cortisol measurement can confirm the catheter's position, thereby increasing the AVS success rate. OBJECTIVE AND METHODS: We developed a quick cortisol assay (QCA) that uses immunochromatography and gold nanoparticles and can be performed either semiquantitatively or quantitatively. The assay was evaluated in two studies. In a single-center study, PA patients were assigned to undergo AVS incorporating the semiquantitative QCA (n = 30), the quantitative QCA (n = 30), or without the QCA (n = 30), and the rates of successful AVS were determined. In a prospective multicenter randomized, controlled study, the success rates of AVS performed with (n = 148) or without (n = 145) the semiquantitative QCA were determined. RESULTS: Cortisol concentrations were measured during AVS in 6 minutes or less in the radiology suite, without additional technical assistance, and significantly correlated with a conventional reference assay (R(2) = 0.994; P < .001). In the single-center study, the differences in the AVS success rates associated with semiquantitative and quantitative QCAs were not significant (both 93%); however, the success rates were significantly higher than the rate of successful AVS performed without using the QCA (63%; P < .001). The success rate of AVS performed in the multicenter study was 94% for the semiquantitative QCA, which was significantly higher than the rate for the patients without QCA (60%; P < .001). CONCLUSIONS: Our novel QCA was rapidly and easily performed at the point of care and improved the rate of successful AVS.
Assuntos
Coleta de Amostras Sanguíneas/métodos , Cromatografia de Afinidade/métodos , Hidrocortisona/análise , Hiperaldosteronismo/diagnóstico , Glândulas Suprarrenais/irrigação sanguínea , Feminino , Ouro , Humanos , Hiperaldosteronismo/sangue , Masculino , Pessoa de Meia-Idade , Nanopartículas , Sistemas Automatizados de Assistência Junto ao Leito , Estudos ProspectivosRESUMO
Severe acute liver dysfunction occurred following transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with massive ascites due to portal hypertension associated with primary myelofibrosis. On US and TIPS venography, we considered that the acute liver ischemia was induced by TIPS. To avoid diffuse hepatic infarction and irreversible liver damage, a balloon catheter was inserted transjugularly into the TIPS tract and occluded it to increase portal venous flow toward the peripheral liver parenchyma. The laboratory data indicating hepatic dysfunction were improved after the procedure. We should pay attention to the possible occurrence of acute hepatic ischemia and infarction after TIPS creation even in a case of noncirrhotic portal hypertension. In such cases, temporary balloon occlusion of TIPS is an effective therapeutic method, probably as a result of inducing the development of arterial compensation through the peribiliary plexus.
Assuntos
Reação de Fase Aguda/etiologia , Oclusão com Balão , Infarto/prevenção & controle , Fígado/irrigação sanguínea , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Mielofibrose Primária/complicações , Humanos , Hipertensão Portal/terapia , Isquemia/etiologia , Circulação Hepática/fisiologia , Masculino , Pessoa de Meia-Idade , Pressão na Veia Porta/fisiologiaRESUMO
The study object was to retrospectively compare the detection rate of hypervascular foci visualized by CT during hepatic arteriography (CTHA) in borderline nodules, which was observed upon cirrhotic livers, on dynamic MDCT, dynamic gadolinium-enhanced MR (dynamic MR), and SPIO-enhanced MR imaging. Eighty-five nodules in 49 patients with cirrhosis were evaluated. When a part of the nodule showed hyperdensity relative to the surrounding areas of the nodule on CTHA, it was defined as "hypervascular focus." The relationships between the dynamic MDCT and dynamic MR and SPIO-enhanced MR imaging findings of these foci were analyzed using X(2) test. Hypervascular foci were detected in 17 (53%) of 32 on the arterial dominant phase of dynamic MDCT, in 19 (37%) of 51 on the arterial dominant phase of dynamic MR and in 6 (26%) of 23 on SPIO-enhanced MR imaging. Arterial dominant phase of dynamic MDCT demonstrated a significantly higher detection rate of hypervascular foci less than 5 mm in diameter than did dynamic and SPIO MR imaging (p<0.05). Hypervascular foci in borderline nodules could be better visualized by dynamic MDCT than by gadolinium- and SPIO-enhanced MR imaging. Dynamic MDCT is recommended for the follow-up examination of hypovascular borderline lesions.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Compostos Férricos , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Neovascularização Patológica/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/irrigação sanguínea , Meios de Contraste , Feminino , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: To retrospectively describe imaging analyses of benign hypervascular hyperplastic liver nodules (HHN) that resulted from alcoholic liver cirrhosis and to examine the possibility of imaging differentiation between these nodules and hypervascular hepatocellular carcinoma (HCC). METHODS: Ten histopathologically confirmed HHN arise in alcoholic liver cirrhosis, and 9 HCC were examined. Magnetic resonance imaging (MRI) (10 HHN and 9 HCC), superparamagnetic iron oxide-enhanced T2-weighted MRI (6 HHN and 4 HCC), and dual-phase computed tomography hepatic arteriography (5 HHN and 6 HCC) were performed, respectively. RESULTS: On T1-weighted magnetic resonance images, 7 HHNs showed hyperintensity and 3 showed iso- to hypointensity, and all HCCs showed hypointensity compared with surrounding liver. On T2-weighted magnetic resonance images, 2 HHNs showed hyperintensity and 8 showed iso- to hypointensity. In contrast, 1 HCC showed hypointensity and 8 showed hyperintensity. On superparamagnetic iron oxide-enhanced T2 MRI, all HHNs showed iso- to hypointensity, and all HCCs showed hyperintensity. All HHN and HCCs subjected to dual-phase computed tomography hepatic arteriography showed enhancement on early-phase images and coronalike enhancement on late-phase images. CONCLUSIONS: Imaging findings of highly-well differentiated HCCs possibly overlap with HHN. So, for correct diagnosis of HHN, at first, we should suspect HHN based on clinical findings and MRI findings, and then perform core needle biopsy to verify the radiological diagnosis.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Cirrose Hepática Alcoólica/diagnóstico , Neoplasias Hepáticas/diagnóstico , Fígado/patologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adulto , Idoso , Angiografia , Diagnóstico Diferencial , Feminino , Compostos Férricos , Humanos , Cirrose Hepática Alcoólica/patologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
We retrospectively evaluate the MR imaging findings of hepatocellular carcinomas (HCC) with biliary tumor thrombi. MR imaging was performed on six patients presenting with obstructive jaundice and/or biliary hemorrhage. T1-weighted images, T2-weighted images, MR cholangiopancreatography (MRCP), and dynamic MR images were obtained. Duodenal endoscopy was performed on all cases and hepatic resection on two cases. HCCs were 1.8-10 cm in diameter (mean 5.8 cm). Biliary tumor thrombi were detected in all patients on MR imaging. Tumor thrombi showed hypointensity on T1-weighted images, hyperintensity on T2-weighted images, and contrast enhancement on the early phase of dynamic MR images. MRCP showed intrahepatic bile duct dilatation in all cases. Biliary hemorrhage was clearly depicted by MR images in five cases and showed hyperintensity on T1-weighted images and hyperintensity or hypointensity on T2-weighted images. Biliary hemorrhage was confirmed by endoscopy in two cases. Portal vein thrombi were also associated in five of six patients. Pathologically, tumor thrombi of HCCs were demonstrated in two patients who underwent hepatic resection. In conclusion, MR imaging is useful for the diagnosis of biliary tumor thrombi from HCC and for evaluating the extension of thrombi and biliary hemorrhage.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Trombose/diagnóstico , Idoso , Carcinoma Hepatocelular/complicações , Colangiopancreatografia por Ressonância Magnética , Meios de Contraste , Endoscopia Gastrointestinal , Feminino , Gadolínio DTPA , Humanos , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose/etiologiaRESUMO
The purpose of this study was to elucidate the role of the superior thyroid artery in intra-arterial infusion chemotherapy for laryngeal and hypopharyngeal cancers. Thirty-nine patients with laryngeal cancer and 29 patients with hypopharyngeal cancer underwent intra-arterial infusion chemotherapy. We performed a retrospective analysis of the feeding arteries confirmed by computed tomography during selective arteriography and compared the results with the extent of the tumors. In 14 of 39 laryngeal and 15 of 29 hypopharyngeal cancers, the tumor did not cross the midline (group 1). In the remaining 25 and 14 cancers, respectively, the tumor crossed the midline or located in the center (group 2). For 13 of 14 laryngeal and 7 of 15 hypopharyngeal cancers in group 1 and for 6 of 25 laryngeal cancers in group 2, the entire tumor was contrast enhanced by the ipsilateral superior thyroid and/or superior laryngeal artery. For 12 of 25 laryngeal and 1 of 14 hypopharyngeal cancers in group 2, the entire tumor was contrast enhanced by the bilateral superior thyroid artery. For the other patients, infusion via the other arterial branches such as the inferior thyroid and the lingual arteries were needed to achieve contrast enhancement of the entire tumor. Superselective intra-arterial chemotherapy for laryngeal cancer from the superior thyroid artery is appropriate, whereas that for hypopharyngeal cancer is less sufficient. To accomplish contrast enhancement of the entire tumor, additional intra-arterial infusion from other arteries such as the inferior thyroid artery is often necessary.
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Artérias/anatomia & histologia , Neoplasias Hipofaríngeas/irrigação sanguínea , Infusões Intra-Arteriais/métodos , Neoplasias Laríngeas/irrigação sanguínea , Idoso , Angiografia , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Artéria Femoral/diagnóstico por imagem , Humanos , Neoplasias Hipofaríngeas/diagnóstico por imagem , Neoplasias Hipofaríngeas/tratamento farmacológico , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Glândula Tireoide/irrigação sanguínea , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To evaluate the efficacy of the saline flush technique for abdominal multidetector-row computed tomography (CT). METHODS: As a clinical study, 147 patients with chronic hepatic disease were divided into two groups: group A, given 100 cc of contrast material flushed with 50 cc of saline; and group B, given 100 cc of contrast material only. The difference in attenuation values between groups A and B, and cirrhotic liver and non-cirrhotic liver were evaluated. As an in-vitro experimental study, time vs. peak pressure curve was obtained changing injection devices. RESULTS: Group B showed a greater contrast enhancement effect in the early arterial equilibrium phase of the aorta and late arterial phase of the liver. In cirrhotic liver, the aorta showed greater contrast enhancement in the early arterial phase in group A. Attenuation values of hypervascular hepatic nodules showed no statistically significant difference between groups A and B. Time to reach peak pressure was prolonged when using saline flush devices in vitro. Flow of contrast material from the contrast material cylinder to the saline cylinder was also discovered. CONCLUSION: Saline flush causes peak arterial contrast to be strong for a short duration. Abdominal organ attenuation values are not necessarily increased in the saline flush method. It is important to know that contrast enhancement is dependent on the injection device.
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Intensificação de Imagem Radiográfica/métodos , Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos , Aorta Abdominal/diagnóstico por imagem , Meios de Contraste , Humanos , Fígado/diagnóstico por imagem , Radiografia Abdominal/instrumentação , Cloreto de Sódio , Tomografia Computadorizada por Raios X/instrumentaçãoRESUMO
PURPOSE: To assess the technical feasibility and efficacy of distal embolus protection with an intra-aortic filter during stent-graft repair in a patient diagnosed with a shaggy aorta. TECHNIQUE: In a 75-year-old man with a severely atherosclerotic thoracic aortic aneurysm, stent-graft repair was combined with transposition of the arch branches to the ascending aorta under thoracotomy. A filtration-type embolus protection device with a nitinol basket and polyester fabric was introduced through a 12-F sheath and opened in the supraceliac aorta during the stent-graft procedure; it was safely pulled back into the sheath after the stent-grafts were implanted. The stent-graft repair was successful, and abundant atheromatous debris was captured in the filter. Neither procedure-related embolic events nor neurological deficits were observed. CONCLUSIONS: Use of the intra-aortic filter device to prevent distal embolism during thoracic stent-graft repairs may be feasible and efficacious in severely atherosclerotic patients.
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Aneurisma da Aorta Torácica/cirurgia , Aterosclerose/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Embolia/prevenção & controle , Stents , Idoso , Ligas , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Meios de Contraste , Estudos de Viabilidade , Humanos , Masculino , Desenho de Prótese , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: To retrospectively determine whether there is a relationship between the intranodular blood supply evaluated at computed tomography (CT) during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) and the magnetic resonance (MR) imaging signal intensity of nodules associated with cirrhosis. MATERIALS AND METHODS: Neither institutional review board approval nor informed consent was required for retrospective reviews of medical records and images. One hundred fourteen hepatocellular nodules 10 mm or greater in largest diameter in 58 patients (39 men, 19 women; mean age, 61 years) with cirrhosis were evaluated at CTAP, CTHA, and MR imaging. The CTAP and CTHA nodule findings were divided into three main types: Type A nodules were isoattenuating at CTAP and hypoattenuating at CTHA; type B nodules, slightly hypoattenuating at CTAP and hypoattenuating at CTHA; and type C nodules, strongly hypoattenuating at CTAP and hyperattenuating at CTHA. The relationships between the CTAP and CTHA findings and the MR imaging signal intensity among these nodules were analyzed by using the chi(2) test. RESULTS: On T1-weighted MR images, 27 (63%) of 43 type A nodules were hyperintense, nine (39%) of 23 type B nodules were isointense, and 19 (48%) of 40 type C nodules were hypointense; differences were not significant. On T2-weighted MR images, 31 (72%) of 43 type A nodules were hypointense (P < .05), 12 (52%) of 23 type B nodules were isointense, and 34 (85%) of 40 type C nodules were hyperintense (P < .05). CONCLUSION: There was a significant association between intranodular blood supply and nodule signal intensity on T2-weighted MR images. However, study findings did not show whether the blood itself (ie, blood volume or blood flow amount) directly influenced the signal intensity.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico , Fígado/irrigação sanguínea , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adulto , Idoso , Angiografia , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/etiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Portografia , Estudos RetrospectivosRESUMO
In a case of esophageal cancer with liver metastases, rupture of a liver metastasis resulted in subcapsular hematoma of the liver. Digital subtraction angiography with carbon dioxide showed multiple extravasations at the surface of the liver suggesting multiple ruptures of the penetrating hepatic capsular arteries. It was suggested that these findings are not rare in cases of subcapsular hematoma; however, they have received little attention.