Mucinous carcinoma of the liver mimicking cavernous hemangioma on pre- and postcontrast MR imaging.
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Adenocarcinoma, Mucinous↗
Biomedical subjects
O Matsui
Publications and source records attributed to O Matsui.
[Long-term effect of transcatheter arterial embolization therapy for renal angiomyolipoma].
We report a case of a 21-year-old man with a right renal angiomyolipoma who has been observed for 20 months after successful treatment with selective transcatheter arterial embolization (TAE). In May 1993, he was transferred to our hospital for the treatment of an abdominal mass. Examination revealed a solid and fat-containing right renal tumor on computed tomography (CT) and magnetic resonance imaging (MRI), hypervascular staining with multiple peripheral microaneurysms on renal angiogram, indicating an angiomyolipoma (AML). He did not have any signs of tuberous sclerosis. Because he complained of abdominal pain and the tumor was 9 cm in diameter, TAE of the tumor using polyvinyl alcohol foam was performed to prevent life-threatening hemorrhage. Renal angiogram after TAE demonstrated a complete shut-down of blood supply to the tumor and CT scan, 6 and 20 months after TAE, demonstrated a decrease in size to 4.5 cm in diameter, showing a favorable long-term effect of treatment. He has been symptom-free for 20 months. TAE appears to be a safe and effective treatment for AML, preventing tumor growth and thus possibly hemorrhage or rupture of the tumor over the long -term.
Adult↗
Hepatocellular carcinoma: CT appearance of parenchymal changes after percutaneous ethanol injection therapy.
PURPOSE: To evaluate the changes in surrounding liver parenchyma after treatment of hepatocellular carcinoma (HCC) and borderline malignant lesions with percutaneous ethanol injection (PEI). MATERIALS AND METHODS: The authors reviewed the findings at computed tomography (CT) and CT during arterial portography (CTAP) obtained before and after PEI therapy for 32 lesions in 26 patients with HCC or adenomatous hyperplasia. Two surgically resected specimens were also histologically examined. RESULTS: In 10 (77%) of 13 lesions, decreased portal vein-related enhancement indicative of reduced portal blood flow in the periphery of the tumor was found at CTAP. Mild atrophy (concave liver surface), segmental atrophy, and lobar atrophy were found in 40%, 17%, and 3%, respectively. Histologic examination of the resected specimens revealed organized thrombi in the peripheral portal vein in the surrounding liver. CONCLUSION: PEI may cause decreased portal blood flow and atrophy in the noncancerous liver parenchyma that surrounds the tumor being treated.
Aged↗
Balloon occlusion during CTAP.
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Carcinoma, Hepatocellular↗
Aberrant gastric venous drainage in cirrhotic livers: imaging findings in focal areas of liver parenchyma.
PURPOSE: To analyze imaging finding in focal areas of liver parenchyma with aberrant gastric venous drainage (AGVD) in cirrhotic livers. MATERIALS AND METHODS: Eighteen patients with AGVD confirmed with computed tomography (CT) during arterial portography and arteriography underwent ultrasound (US) (n = 18), CT (n = 18), magnetic resonance (MR) imaging (n = 12), dynamic CT (n = 14), and dynamic MR imaging (n = 8). Imaging and histologic (n = 2) findings were analyzed. RESULTS: The focal area with AGVD was hypoechoic on US scans (n = 7), hypoattenuating on CT scans (n = 4), hyperintense on T1-weighted MR images (n = 6), and hypointense on T2-weighted MR images (n = 5). Early enhancement was seen with dynamic CT (n = 8) and with dynamic MR imaging (n = 6), without definite staining on arterial phase of arteriography. Histologic findings revealed hyperplastic changes of liver. CONCLUSION: The imaging findings, except for early enhancement, were very similar to those of adenomatous hyperplasia or well-differentiated hepatocellular carcinoma. The early enhancement was considered due to early venous return compared with that of the surrounding liver.
Adenoma↗
Focal sparing of segment IV in fatty livers shown by sonography and CT: correlation with aberrant gastric venous drainage.
OBJECTIVE: One of the most common sites of focal sparing in fatty livers (focal spared area) shown by sonography or CT is the posterior edge of segment IV. The differentiation of such a focal spared area from tumor has been a diagnostic challenge. The purpose of this study was to determine if a correlation exists between the focal spared area at the posterior edge of segment IV in fatty liver and the decrease of portal perfusion from the main portal vein due to aberrant gastric venous drainage directed into segment IV. SUBJECTS AND METHODS: Seventeen patients with fatty liver diagnosed on the basis of sonographic and CT findings who had hepatic arteriography and/or CT during arterial portography (CTAP) were included in the study. Seven patients had a focal spared area more than 2 cm in the longest diameter at the posterior edge of segment IV, and 10 patients did not have a focal spared area. The frequency of aberrant gastric venous drainage shown by arteriography (17 patients) and/or by CTAP (15 patients) was compared in the two groups of patients. RESULTS: Hepatic arteriography showed aberrant gastric venous drainage in all patients who had a spared area, and CTAP showed a portal perfusion defect at the posterior edge of segment IV in all five patients with a focal spared area who underwent CTAP. On the other hand, no definite aberrant gastric venous drainage and portal perfusion defect were seen in any patient without a spared area. The difference in the frequency of aberrant gastric venous drainage between the two groups of patients was statistically significant (chi-square test, p < .0001). CONCLUSION: Our results show that a strong correlation exists between the focal spared area at the posterior edge of segment IV in fatty liver and aberrant gastric venous drainage directed to segment IV. Focally decreased blood flow from the main portal vein associated with aberrant gastric venous drainage is a likely cause of the focal spared area. This fact is important for the differential diagnosis of hepatic tumors.
Adult↗
[Effect of copper and copper binding protein on the CT attenuation value of liver: experimental study in rats].
We analyzed the effect of copper and copper binding protein on CT attenuation value in a rat model. CT attenuation values of the liver were compared with hepatic copper content and grade of orcein-positive granules, which are thought to be a counterpart of polymerized methalothionein in lysosomes. The difference between hepatic copper and CT attenuation value was not statistically significant (R = 0.056, p = 0.96). CT value had a positive correlation with the grade of orcein-positive granules (Rho = 0.755, p = 0.0001). We concluded that the CT attenuation value of liver can be elevated by rich polymerized methalothionein (copper binding protein) in lysosomes.
Animals↗
Long-term survival of peripheral intrahepatic cholangiocarcinoma with distant metastasis.
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Bile Duct Neoplasms↗
[Experimental study on embolic materials for simultaneous segmental embolization through transarterial route].
To determine suitable embolic materials for simultaneous arterioportal embolization through the arterial route, transcatheter arterial embolization (TAE) using iodized oil (Lipiodol) mixed with monomeric n-butyl-2-cyanoacrylate, with absolute ethanol, or mixed with Gelfoam powder was carried out in 14 dogs. Following TAE, the distribution of Lipiodol in hepatic artery, peribiliary plexus, and portal vein was analyzed by soft tissue x-ray radiography and en bloc silver impregnation. As a result, Lipiodol mixed with absolute ethanol, and Gelfoam powder was considered to be the most reasonable embolic materials for this purpose.
Animals↗
Subsegmental transcatheter arterial embolization for small hepatocellular carcinomas: local therapeutic effect and 5-year survival rate.
The local therapeutic effects and 5-year survival rates obtained following subsegmental transcatheter arterial embolization (TAE) therapy for small hepatocellular carcinomas (HCCs) were retrospectively analyzed. A total of 124 nodular-type HCC lesions measuring less than 4 cm in diameter in 100 patients with liver cirrhosis were subjected to the analysis. All lesions became opaque on digital subtraction angiography. Complete necrosis was seen in 64% of 11 resected lesions. Among the remaining 113 lesions, the 1- and 5-year local recurrence rates following one performance of TAE were 18% and 33%, respectively. The 1- and 5-year survival rates were 100% and 53%, respectively. No significant side effect was observed after TAE therapy. Subsegmental TAE therapy significantly improved the long-term survival rates of patients with small HCCs associated with liver cirrhosis as compared with those treated by conventional TAE therapy.
Adult↗
Coronary steal caused by a right gastroepiploic artery graft.
We report a patient with coronary artery steal after gastroepiploic artery grafting to the right coronary artery. The coronary artery steal syndrome involves reversed flow in the gastroepiploic artery, which siphons blood from the heart and results in myocardial ischemia.
Adult↗
Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection.
BACKGROUND/AIMS: Prognostic analysis on hepatocellular carcinoma (HCC) in patients undergoing hepatectomy is necessary to determine the clinical value of hepatectomy on prognosis. METHODS: Survival and disease-free survival were analyzed in 104 HCC patients undergoing hepatectomy using clinicopathologic factors by univariate and multivariate analyses. The value of the International Union Against Cancer (UICC) TNM classification on prognosis was assessed in the patients. RESULTS: In multivariate analysis, portal vein invasion was the most influential factor. The difference between stage 1 and 2 or stage 3 and 4A using UICC's TNM classification was not significant with respect to survival or disease-free survival. The UICC's classification was modified as follows; stage 1, solitary tumor without vascular invasion; stage 2, solitary or multiple tumor(s) involving adjacent to vessel branch; stage 3, tumor(s) involving major vessel branch or with regional lymph nodal metastasis; and stage 4, tumor(s) with distant metastasis. The differences between each stage in the modified classification were significant with respect to disease-free survival. CONCLUSIONS: The UICC's TNM classification was not of prognostic significance. Further studies on survival in patients with HCC are necessary to evaluate the value of the UICC's TNM classification; some modification may be necessary.
Adolescent↗
Intrahepatic peribiliary vascular plexus in various hepatobiliary diseases: a histological survey.
The peribiliary vascular plexus (PVP) plays an important role in the pathophysiology of the biliary tree. We histologically examined vascular endothelial cells of the intrahepatic PVP in various hepatobiliary diseases by immunohistochemistry and lectin histochemistry with antibodies to factor VIII-related antigens (F-VIII-R-Ag) and Ulex europaeus agglutinin I (UEA-I). The PVP around the intrahepatic large bile ducts (LBDs) and septal bile ducts (SBDs) in normal livers consists of three layers: inner layer vessels immediately adjacent to the epithelium, intermediate layer vessels within the ductal wall, and outer layer vessels outside the ductal wall. In some bile ducts that show active inflammation in hepatolithiasis, primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and extrahepatic biliary obstruction (EBO), vessels in the intermediate layer and, to a lesser degree, in the inner layer, are increased in number. In sclerotic bile ducts of PSC, EBO, and hepatolithiasis, the number of inner and intermediate layer vessels are markedly and variably reduced, respectively. In liver cirrhosis or chronic advanced liver diseases, the vessels in all three layers, particularly those in the outer layer, are increased in number and dilated, probably reflecting intrahepatic microcirculatory disturbance. The PVP showed several types of numerical and luminal changes, each of which may be related to disease processes in the intrahepatic biliary tree as well as to intrahepatic microcirculatory disturbance.
Adult↗
Large scale clinical evaluation of bowel contrast agent containing ferric ammonium citrate in MRI.
Clear identification of bowel has been thought to be essential in diagnosis by abdominal MRI. We have completed the clinical phase III trial of a new oral contrast agent (FerriSeltz) which is a ferric ammonium citrate based bowel contrast agent. FerriSeltz is a powder that is dissolved in 300 ml water to create a grape-flavored effervescent drink. We have evaluated the usefulness of FerriSeltz, and compared groups receiving 600 mg and 1200 mg of ferric ammonium citrate, the use and nonuse of parasympathetic blockers, and patients with and without fasting in 174 patients who underwent abdominal MRI using this agent. FerriSeltz was found to brighten the stomach and duodenum, contribute to the improvement in diagnostic efficacy, be safe as a bowel contrast agent in abdominal MRI, and be associated with an extremely low incidence of side effects (only mild diarrhea in one of 169 patients). No significant differences were found in the contribution to the improvement in diagnostic efficacy between the two dosage groups, the use and nonuse of parasympathetic blockers, or patients with and without fasting. We concluded that ferric ammonium citrate based compound (FerriSeltz) is a promising bowel contrast agent in abdominal MRI.
Abdominal Neoplasms↗
Pseudolesion in segment IV of the liver at CT during arterial portography: correlation with aberrant gastric venous drainage.
PURPOSE: To analyze the correlation between pseudolesions seen in segment IV of the liver and aberrant gastric venous drainage (AGVD). MATERIALS AND METHODS: Twenty-two patients with a pseudolesion in the posterior edge of segment IV of the liver (group A) and 100 randomly selected patients without pseudolesions (group B) underwent computed tomography during arterial portography (CTAP) and hepatic arteriography. The frequency of the visualization of AGVD to segment IV was compared for groups A and B. RESULTS: AGVD was seen at arteriography in 18 of 22 patients in group A. None of the patients in group B had AGVD. The difference in the frequency of angiographically visible AGVD was statistically significant (chi 2 test, P < .01). CONCLUSION: AGVD is the main cause of pseudolesions in the posterior edge of segment IV of the liver.
Diagnosis, Differential↗
Segmental iron deposition in the liver due to decreased intrahepatic portal perfusion: findings at MR imaging.
PURPOSE: To evaluate the causes of intrahepatic segmental areas of signal hypointensity [corrected] on T1- and T2-weighted spin-echo (SE) and gradient-echo (GRE) magnetic resonance (MR) images. MATERIALS AND METHODS: Six patients in whom wedge-shaped hypointense areas were seen on hepatic MR images underwent examination with ultrasound (US), computed tomography (CT), angiography, and CT during arterial portography (CTAP). Histologic examination was performed in three patients. RESULTS: The affected liver parenchymas were best depicted as segmental or lobar hypointense areas on GRE images. Angiography and CTAP revealed that portal blood supply to the hypointense areas was absent or decreased due to portal vein tumor thrombus and arterioportal shunt (n = 1), compression of a portal branch by tumor (n = 2), portal vein thrombosis (n = 1), or arterioportal shunt (n = 2). Iron deposition in the hepatocytes was evident in all three patients with histologic correlation. CONCLUSION: Segmental signal hypocoagulability was generally due to hepatocyte iron deposition and was accompanied and possibly caused by a disturbance in portal flow.
Adult↗
Small pancreatic adenocarcinomas: efficacy of MR imaging with fat suppression and gadolinium enhancement.
PURPOSE: To compare the efficacy of fat-suppressed T1-weighted magnetic resonance (MR) imaging and dynamic MR imaging in the diagnosis of small pancreatic adenocarcinomas. MATERIALS AND METHODS: Pancreatic adenocarcinomas in 15 patients were evaluated with dynamic computed tomography (CT) and five MR imaging sequences that included fat-suppressed T1-weighted technique and dynamic multiplanar gradient-recalled acquisition in the steady state technique. RESULTS: The difference in contrast-to-noise ratios between tumor and normal pancreas was significantly different (P < .05) between the five MR imaging sequences used. In six patients, the combination of dynamic MR imaging and fat-suppressed imaging was superior to dynamic CT in the detection of tumors. Tumors accompanied by chronic pancreatitis were less distinct on fat-suppressed images but were clearly visible on dynamic MR images. Peripancreatic extension of tumors was better recognized on T1-weighted images and CT scans than on fat-suppressed images. CONCLUSION: Fat-suppressed T1-weighted images and dynamic MR images were useful in the detection of pancreatic carcinomas. T1-weighted images and CT scans were superior in the evaluation of tumor extension.
Adenocarcinoma↗
Postoperative adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs in patients with hepatocellular carcinoma.
Vascular invasion and intrahepatic metastasis by hepatocellular carcinoma are important factors predisposing to tumor recurrence. Recurrences of this malignancy occur frequently in residual liver, and its prevention is one of the most important factors in obtaining better surgical survival. Fifty patients who underwent hepatectomy for invasive hepatocellular carcinoma with vascular invasion and/or intrahepatic metastases were studied to evaluate the effect of adjuvant bolus hepatic arterial infusion of iodized poppyseed oil (Lipiodol) containing anticancer drugs in preventing recurrence and in prolonging survival. Patients were assigned to two treatment groups. Twenty-three of the fifty patients received adjuvant bolus infusion of Lipiodol containing doxorubicin and mitomycin C, whereas 27 patients received no therapy. The disease-free survival rate for the patients who received adjuvant therapy was significantly better (p < 0.05) than that for those who did not when measured at 172, 516, 688 and 860 days after hepatectomy, and the disease-free survival curve for patients with adjuvant therapy was significantly (p = 0.0237) better than that without adjuvant therapy. The cumulative survival rates and curves were not significantly different between the two groups. While adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs was effective in improving disease-free survival, the effect was not satisfactory. Further trials of adjuvant chemotherapy are required to improve the surgical survival of hepatocellular carcinoma patients.
Aged↗