[Imaging diagnosis of biliary cystadenoma and cystadenocarcinoma].
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Biomedical subjects
Publications and source records attributed to K Ohtomo.
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Fifteen patients with primary intrahepatic biliary malignancy (cholangiocarcinoma in 13, biliary cystadenocarcinoma in two) were examined by computed tomography (CT). The CT features were classified into three types: (A) a well-defined round cystic mass with internal papillary projections, (B) a localized intrahepatic biliary dilatation without a definite mass lesion, and (C) miscellaneous low-density masses. Intrahepatic biliary dilatation was noted in all cases of Types A and B and half of those of Type C; dilatation of extrahepatic bile ducts occurred in 4/4, 1/3, and 0/8, respectively. CT patterns, such as a well-defined round cystic mass with papillary projections or dilatation of intra- and extrahepatic ducts, give important clues leading to a correct diagnosis of primary intrahepatic biliary malignancy.
Accuracy and limitations of computed tomography (CT) and sonography in the detection and diagnosis of cavernous hemangioma of the liver were analyzed in 39 cases. In 35 of 38 lesions examined by CT before and after bolus contrast enhancement, findings were dense contrast enhancement spreading in all directions on subsequent scans and/or density (other than capsule or septa) higher than normal hepatic parenchyma after 2 min. Lesions smaller than 1 cm were not detected. Misregistration in sequential scans prevented diagnosis of three of nine lesions smaller than 2 cm. Sonography revealed various patterns of mass, but in the smaller lesions, an extremely hyperechoic pattern was dominant. The contributions of CT and sonography depend on the size of the lesions.
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Computed tomographic (CT) and ultrasonographic (US) images of 17 patients with septate cystic lesions in the upper abdomen were reviewed. US was superior to CT in detecting septation and its presence suggested that the 'cyst' was neoplastic in nine. CT plays a complementary role in differentiating cystic lesions.
Ten cases of cystadenoma or cystadenocarcinoma of the pancreas were examined by computed tomography (CT). All but one showed characteristic findings consisting of both cystic and solid components. Innumerable small cysts producing a honeycomb appearance were noticed in serous cystadenomas. A well-defined multilocular cystic mass containing thin, straight, and/or curvilinear septa or a unilocular cystic tumor with a papillary projection and locally thickened wall was present in mucinous cystadenomas. The CT findings in cystadenocarcinomas varied depending on the relative size of the cystic and solid portions and the grade of malignancy. CT was useful in detecting and diagnosing cystic neoplasms of the pancreas and differentiating benign serous cystadenomas from potentially malignant cystadenomas in typical cases. However, aspiration biopsy is recommended when findings are equivocal.
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