PURPOSE: To evaluate the therapeutic effect of percutaneous transhepatic biliary drainage (PTBD) in patients with obstructive jaundice caused by biliary involvement of hepatocellular carcinomas (HCC) and to determine the prognostic factors. METHODS: We retrospectively analyzed the data of 22 consecutive patients (M:F = 20:2, mean age 52.8 years). Inclusion criteria were the patient having obstructive jaundice caused by HCC that invaded the bile ducts and having at least 4 weeks of follow-up data after the PTBD. We defined "good response" and "poor response" as whether the level of total bilirubin decreased more than 50% in 4 weeks or not. Total bilirubin level (T-bil), Child-Pugh score and the location of biliary obstruction for the two groups were compared. In addition, the interval between clinical onset of jaundice and PTBD, the degree of parenchymal atrophy and the size of the primary tumor were compared. RESULTS: Of the 22 patients, 13 (59.1%) showed good response. T-bil was significantly lower in the good response group than in the poor (14.2 +/- 6 mg/dl vs 25.9 +/- 13.8 mg/dl, p =.017). In the five patients with T-bil <10 mg/dl, four (80%) showed good response, while in nine patients with T-bil > 20 mg/dl, only three (33%) showed good response. Although statistically not significant, patients with Child score <10 showed better results [good response rate of 66.7% (12/18)] than patients with Child score > or = 10 [good response rate of 25% (1/4)]. Involvement of secondary confluence of the bile duct also served as a poor prognostic factor (p = 0.235). The interval between clinical onset of jaundice and PTBD, the presence of parenchymal atrophy and the size of the tumor did not show significant effect. CONCLUSION: Early and effective biliary drainage might be necessary in this group of patients with limited hepatic function.

Carcinoma, Hepatocellular↗

PubMed2002

Primary colorectal lymphoma: spectrum of imaging findings with pathologic correlation.

Primary colorectal lymphoma is a very uncommon disease; therefore, it has received little attention in the radiology literature. Moreover, imaging features of newly described pathologic subtypes have not been reported such as low-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue and peripheral T-cell lymphoma that involves colorectal area. We retrospectively reviewed double-contrast barium enema and CT scans in the patients with primary colorectal lymphoma. In this article the radiologic appearances of primary colorectal lymphoma are categorized into focal lesion and diffuse lesion. Focal lesion includes polypoid mass, circumferential infiltration with smooth mucosal surface, circumferential infiltration with extensive ulceration, cavitary mass, mucosal nodularity, and mucosal fold thickening. Diffuse lesion includes diffuse ulcerative lesion and diffuse nodular lesion. Peripheral T-cell lymphomas that involve the colon manifested as either a diffuse or focal segmental lesion and showed extensive mucosal ulceration. These findings are similar to those of Crohn's disease or tuberculous colitis and are different from those of previously reported colorectal lymphoma. Low-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue manifest as multiple mucosal nodularity. The imaging features of primary colorectal lymphoma are quite variable and overlap with other colonic pathology; however, it is important for radiologists to know the imaging features of primary colorectal lymphoma with their pathologic correlation.

Barium Sulfate↗

PubMed2002

Improved sonographic imaging of hepatic hemangioma with contrast-enhanced coded harmonic angiography: comparison with MR imaging.

The aim of this study was to compare peripheral nodular enhancement with centripetal progression on contrast-enhanced coded harmonic angio (CHA) with those as seen on magnetic resonance imaging (MRI) scan. A total of 20 patients with 24 hemangiomas confirmed by dynamic contrast-enhanced MRI were included in this study. All 20 patients were examined with CHA in conjunction with a galactose-based microbubble contrast agent (SH U 508A) and with interval delay scanning. The pattern and the time of contrast enhancement were recorded on CHA images. We compared CHA images with MRI in terms of the similarity of contrast-enhanced peripheral nodules. The significance of size of tumor and baseline echogenicity on the ability to see peripheral nodular enhancement was independently assessed. Peripheral nodular enhancement was shown on CHA in 22 (92%) of 24 hemangiomas. Of 22 hemangiomas, 21 (95%) with peripheral nodular enhancement had progressive centripetal fill-in on CHA images. In 4 (80%) of 5 hemangiomas less than 1.5 cm in diameter, contrast-enhanced peripheral nodules were depicted on CHA images. In terms of the similarity of peripheral nodules, CHA images showed the similarity more than "similar" grade with MRI in 21 (95%) of 22 hemangiomas. This study shows that CHA is approximately equal to MRI in its ability to show peripheral nodular enhancement with centripetal progression, even in small hemangiomas.

Adult↗

PubMed2002

Functional analysis of gallbladder using three-dimensional ultrasound: preliminary results.

In evaluating gallbladder function, the clinical feasibility of three-dimensional (3-D) ultrasound (US) using volumetric acquisition was assessed in 30 patients: 18 patients with gallstones and 12 healthy volunteers. 3-D ultrasonography was performed in each patient before and after a fat-meal test. The ejection fraction of the gallbladder from two volumes measured by computer-aided analysis was calculated. There were significant differences in the gallbladder ejection fractions among the diseased and control groups (p < 0.0001). Compared with the results of oral cholecystograms, the ejection fraction of the gallbladder using 3-D volumetry and the grade of oral cholecystography showed good correlation in predicting the gallbladder dysfunction (gamma = 0.71, p = 0.002). Even in cases failing oral cholecystography, the gallbladder ejection fraction using 3-D US was calculated without any difficulty. Conclusively, volumetric acquisition of 3-D US enables us to evaluate gallbladder function and provides a reliable diagnostic yield superior to oral cholecystography.

Adult↗

PubMed2002

Palliative percutaneous tube enterostomy in afferent-loop syndrome presenting as jaundice: clinical effectiveness.

The purpose of this study was to investigate the clinical effectiveness of percutaneous tube enterostomy in afferent loop syndrome presenting as jaundice. Tube enterostomy was successfully performed in seven patients without procedural complications. The serum bilirubin level normalized in five patients but remained elevated in the other two, presumably related to more proximal bile duct obstruction. Percutaneous tube enterostomy is an effective palliative treatment in afferent loop syndrome presenting as an obstructing jaundice. However, coexisting biliary obstruction might be problematic for relieving jaundice with tube enterostomy.

Adult↗

PubMed2002

A straightforward algorithm for the quantification of power Doppler signals.

RATIONALE AND OBJECTIVES: To document a simple algorithm that quantifies power Doppler signals by computer-based statistical image analysis. METHODS: Personal computer-based software was developed. Color pixels representing power Doppler signals were separated from the background gray pixels in power Doppler images converted in BMP format. To avoid misregistration during this segmentation, a threshold value is required to adequately distinguish between gray and color pixels. Equating the intensity of each color pixel to a Power Value (PV), a histogram of Power Values in power Doppler images was obtained. RESULTS: The software was designed to allow users to adjust two thresholds (Difference Threshold and Intensity Threshold) by observing the segmentation results in real time. The software calculates the following indexes within any region of interest as defined by the operator: mean PV, peak PV, standard deviation of PV, percentage power Doppler area, and integrated PV per unit area. CONCLUSIONS: Power Doppler signals can be objectively quantified using this straightforward algorithm. This simple and practical method can be applied to comparative or longitudinal studies upon vascularity or blood flow.

Algorithms↗

PubMed2002

Hepatic arterial and portal venous phase helical CT in patients treated with transcatheter arterial chemoembolization for hepatocellular carcinoma: added value of unenhanced images.

PURPOSE: To evaluate the additional diagnostic value of unenhanced computed tomographic (CT) images in the depiction of viable tumor in patients who were treated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and followed up with biphasic helical CT that included the acquisition of unenhanced images. MATERIALS AND METHODS: We performed helical CT (with unenhanced, arterial, and portal phases) in 54 patients who had been treated with TACE for HCC. Image analysis was first performed with only those images obtained in the arterial and portal venous phases of helical CT. A second analysis was then performed with unenhanced images, arterial images, and portal venous images that focused on the additional value of unenhanced images. The value of additional unenhanced images was evaluated by means of interobserver agreement (kappa statistic) and receiver operating characteristic (ROC) analysis. RESULTS: The two readers detected 128 and 129 lesions. Unenhanced images were valuable for 32 of 129 lesions (23 patients) for reader 1 and for 29 of 128 lesions (21 patients) for reader 2. Although there was no significant difference between biphasic CT alone and biphasic CT with unenhanced images, results of ROC analysis showed higher diagnostic performance with biphasic CT with unenhanced images than with biphasic CT alone for detecting viable tumor. CONCLUSION: The study data demonstrate the diagnostic value of unenhanced images interpreted in conjunction with biphasic CT images for follow-up of patients who have previously been treated with TACE for HCC.

Carcinoma, Hepatocellular↗

PubMed2002

Improved blood compatibility by sustained release of heparin-deoxycholic acid conjugates in a PCL-PEG multiblock copolymer matrix.

The heparin and deoxycholic acid conjugate (heparin-DOCA) synthesized in this study has an amphiphilic property and could be completely dissolved in a co-solvent made of 1,4-dioxane (50 v/v%), n-propanol (25 v/v%), and water (25 v/v%). A polycaprolacton (PCL)-polyethylene glycol (PEG) multiblock copolymer was used as the coating matrix; this polymer also dissolved readily in the same co-solvent. Heparin-DOCA and the PCL-PEG multiblock copolymer were mixed well to produce a transparent coated film on an angio-catheter. The bioactivity of the released heparin-DOCA was determined by evaluating platelet adhesion and fibrin formation on the coated surfaces. The release rate could be controlled by the loading amount of the drug and drug release was maintained for 12 h. The released heparin-DOCA significantly prevented platelet adhesion and fibrin formation at the surfaces, as well as in the bulk in the plasma.

Animals↗

PubMed2002

Fluoroscopically guided placement of a covered self-expandable metallic stent for malignant antroduodenal obstructions: preliminary results in 18 patients.

OBJECTIVE: The purpose of this study was to investigate the technical feasibility and the clinical effectiveness of fluoroscopically guided placement of covered self-expandable metallic stents in the treatment of malignant antroduodenal obstructions. SUBJECTS AND METHODS: With fluoroscopic guidance, covered self-expandable metallic stents were placed in 18 consecutive patients with inoperable malignant antroduodenal obstructions. All patients were treated for severe nausea and recurrent vomiting. RESULTS: Stent placement was technically successful in all patients with or without gastrostomy (n = 2) and balloon dilatation (n = 3). After stent placement, symptoms improved in all but one patient, who had another stenosis in the proximal jejunum. During the follow-up of 2-73 weeks (mean, 12 weeks), stent migration occurred in three patients (16.7%) from 1 to 41 days after the procedure. These patients were treated successfully by means of placing a second covered metallic stent. Two patients, who were followed up for longer than 30 weeks, showed a recurrence of strictures because of mechanical failure of the stents; one of the patients was treated with coaxial placement of a second covered metallic stent, which had a positive clinical outcome. CONCLUSION: Fluoroscopically guided placement of covered self-expandable metallic stents is technically feasible and effective for the palliative treatment of inoperable malignant antroduodenal obstructions. The rate of stent migration in our study was lower than those in previous reports.

Adult↗

PubMed2002

Hepatocellular carcinoma: contrast enhancement with Levovist.

OBJECTIVE: To present the sonographic appearance of hepatocellular carcinoma imaged with the intravenous contrast agent Levovist. METHODS: We reviewed our experience using Levovist (Schering AG, Berlin, Germany) for the sonographic diagnosis of hepatocellular carcinoma. RESULTS: Contrast-enhanced sonography with Levovist facilitated detailed evaluation of tumor vascularity in hepatocellular carcinoma. CONCLUSIONS: Contrast-enhanced sonography with Levovist enhances the role of sonography in the diagnosis of hepatocellular carcinoma. It provides detailed information about tumor vascularity and the contrast enhancement pattern.

Carcinoma, Hepatocellular↗

PubMed2002

Three-dimensional ultrasonography using the minimum transparent mode in obstructive biliary diseases: early experience.

OBJECTIVE: To assess the feasibility of three-dimensional ultrasonography using the minimum transparent mode in patients with obstructive biliary disease. METHODS: Fourteen patients with obstructive jaundice underwent three-dimensional ultrasonography after conventional two-dimensional ultrasonography before interventional procedures. Three-dimensional images reconstructed by the minimum transparent mode were evaluated and compared with direct cholangiography. The minimum transparent mode images were compared with the two-dimensional ultrasonographic images to determine whether additional information was obtained. RESULTS: The level of obstruction was correctly depicted in all patients, and a dilated common bile duct, common hepatic duct, gallbladder, and main intrahepatic ducts were well visualized on minimum transparent mode images. The findings on minimum transparent mode images were well correlated with those on cholangiography; however, the perspective of the whole biliary tree on minimum transparent mode images was inferior to that on cholangiography in all cases. The overall image quality of minimum transparent mode images was poor in 6 patients, fair in 3, good in 4, and excellent in 1. The biliary anatomy was more objectively visualized on the minimum transparent mode images than conventional two-dimensional ultrasonographic images. CONCLUSIONS: Three-dimensional ultrasonography using the minimum transparent mode appears to be clinically feasible. The biliary anatomy was more objectively visualized on the minimum transparent mode images than conventional two-dimensional ultrasonographic images. Further technical development is needed to improve imaging resolution.

Aged↗

PubMed2002

[Spontaneous intrahepatic portosystemic shunt].

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Aged↗

PubMed2002

[Liver metastasis of colon cancer].

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Colonic Neoplasms↗

PubMed2002

[Peripheral cholangiocarcinoma].

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Aged↗