肝脏局限性结节性增生的超声与病理对照研究

目的：讨论肝脏局限性结节性增生（FNH）的超声表现及病理基础。方法：回顾性分析13个病理证实的FNH的超声特点并与病理对照。结果：结节大小为2．4－13．7cm,低回声8例,等回声4例,中高回声1例,5例病灶内见星状强回声区,B超显示4例结节内血管图像,多普勒超声于病灶内记录到丰富的低阻动脉频谱（能量多普勒显示全部病灶,彩色多普勒示11／13呈富血供）,7例病灶内血管呈放射状排列。结论 ;彩色多普勒和能量多普勒超声能够显示FNH的特征性血流表现,提高对FNH的诊断率。     

Power Doppler imaging and evaluation of the resistive index in focal nodular hyperplasia of the liver

Focal lesions of the liver represent a significant diagnostic problem for various imaging modalities. The aim of this study was to assess the value of power Doppler sonography versus conventional color Doppler imaging in the depiction of hypervascular focal nodular hyperplasia (FNH) of the liver and to investigate the resistive index (RI) in the lesions' feeding arteries. Eighteen histologically proved FNHs in 14 patients were evaluated by gray-scale ultrasound, conventional color Doppler, and power Doppler sonography. With conventional color Doppler, a feeding arterial vessel could be depicted in only 4/18 lesions and hypervascularization was detected in 6/18 lesions. Power Doppler was more sensitive in detecting feeding arteries (16/18) within hypervascular lesions (15/18). RI values in the feeding arteries (mean = 0.51) significantly differed from those in the main hepatic artery or its intraparenchymal branches (mean = 0.68) in the same patient. The mean RI-difference was 0.19, suggesting hemodynamically significant arteriovenous shunting. Power Doppler sonography significantly increases sensitivity in the diagnosis of focal nodular hyperplasia of the liver and reliably permits the distinction of these lesions from hepatocellular carcinomas. Received: 17 January 1996/Accepted after revision: 8 May 1996     

肝局灶性结节性增生的超声和CT对照分析

目的 探讨肝局灶性结节性增生（FNH）的超声和CT表现及其诊断价值。方法 15例住院病例行超声与CT检查。结果 15例FNH均经手术及病理证实,共有16个病灶,其中右叶9个,左叶6个,尾叶1个,B超和CT均全部检出,B超多表现为低或略低回声（88%）,可有浅淡暗环（44%）;彩色多普勒显示有粗大血管进入病灶内并分支（81%）,可呈轮辐状血流（19%）,脉冲多普勒均测及动脉血流,阻力指数平均为0.54。CT表现为病灶增强后,早期明显强化（100%）,星状疤痕显示率为44%,门静脉期及延迟扫描多呈等密度（75%）,常规B超联合彩色多普勒超声诊断FNH的符合率为50%;CT诊断FNH的符合率为50%。结论 常规超声联合彩色多普勒超声和CT增强结合动脉扫描可提高FNH的诊断准确性。     

Abdominal involvement in neurofibromatosis 1: sonographic findings

Background: Neurofibromatosis 1 (NF1) has been studied from many viewpoints, but its abdominal involvement has rarely been reported. Sonography (US) is now the initial diagnostic tool for abdominal exploration, which prompted us to determine the clinical manifestations and US findings of abdominal involvement in NF1. Methods: We analyzed the US findings and clinical data of eight NF1 cases with abdominal involvement. Results: Abdominal involvement included neurofibromatous tumor growth in the liver, mesentery, and retroperitoneum, in addition to mesenteric leiomyomatosis and gastric carcinoma. Color Doppler US was useful not only in detecting blood flows in the lesions but also in preventing hazardous vascular injury during tumor biopsy. Conclusion: A better understanding of the clinical manifestations and US findings of abdominal involvement in NF1 translates into improved NF1 patient care. Received: 6 October 1999/Revision accepted: 26 January 2000     

Small hepatocellular carcinoma: differentiation from adenomatous hyperplasia with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging

Background: To investigate the usefulness of color Doppler ultrasound (US) and dynamic Gd-DTPA-enhanced magnetic resonance (MR) imaging in the differentiation of small hepatocellular carcinoma (HCC) and adenomatous hyperplasia (AH). Methods: Thirty-eight small (3 cm or less) nodular lesions (in 38 cirrhotic patients) with US features consistent with HCC underwent evaluation with color Doppler US and MR imaging. Breath-hold T1-weighted rapid acquisition spin echo MR sequence after bolus injection of 0.1 mmol/kg gadopentetate dimeglumine was used to evaluate dynamic enhancement. US-guided tissue-core percutaneous biopsy established the diagnosis: HCC in 28 cases and AH in 10. Results: Color signals with pulsatile or continuous Doppler spectrum were demonstrated in 19 of 28 HCCs (68%) but in none of the AHs. Although there was considerable overlap in signal intensity between HCC and AH on both unenhanced T1- and T2-weighted images, early enhancement on breath-hold T1-weighted images obtained 40 s after starting contrast administration was observed in 22 of 28 HCCs (79%) but in none of the AHs. In 26 of 28 HCCs (93%), pulsatile or continuous flow at color Doppler US, early enhancement at dynamic MR imaging, or both were observed. Conclusion: Findings with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging enable a reliable distinction between small HCC and AH. Received: 8 August 1994/Accepted after revision: 27 January 1995     

Splenic lymphoma: differentiation from splenic cyst with ultrasonography

Background and Methods: Lymphoma can be nearly anechoic and mimic a cyst on ultrasonography (US). To investigate whether this phenomenon occurs at the level of the spleen, we analyzed the US findings of 38 cases of splenic lymphoma and 16 cases of splenic cyst. Results: (1) With regard to shape, echogenicity of the lesion, and mode of posterior echo, there was no difference between splenic lymphomas and splenic cysts. However, the boundaries of the lesions were indistinct in splenic lymphomas and distinct in splenic cysts. (2) Blood flow signals and vascular penetration were seen exclusively in splenic lymphomas. Conclusion: The mode of boundary echo (distinct or indistinct) distinguishes splenic lymphomas from splenic cysts. Color Doppler US increases the diagnostic confidence of US. Received: 25 September 2000/Revision accepted: 27 December 2000     

Portal tumor thrombus due to gastrointestinal cancer

Methods: We studied the clinical data of seven patients with portal tumor thrombus (PTT) due to gastrointestinal (GI) cancer to determine the radiologic patterns and clinical implications of this rare complication. Results: (a) PTT was located along the entire splenic vein in three cases, at the splenomesenteric confluence in one case, and in the superior mesenteric vein in one case. Intrahepatic PTT occurred in two of four cases with liver metastasis. (b) One cirrhotic case was complicated by the occurrence of colon cancer associated with PTT in the splenic vein; the esophageal varices became rapidly enlarged and poorly controlled, and the patient died due to repeated variceal rupture. (c) In all patients, abdominal sonography (US) detected PTT and color Doppler sonography confirmed the US findings. Conclusions: The splenic vein should be meticulously observed by color Doppler sonography to check for PTT in patients with GI cancer to improve patient care. Received: 29 December 1998/Accepted: 24 February 1999     

Evaluation of the intratumoral vasculature of hepatocellular carcinoma by power Doppler sonography: advantages and disadvantages versus conventional color Doppler sonography

Background: To determine whether a difference exists in the relative ability of power Doppler sonography and conventional color Doppler sonography to detect the intratumoral vasculature of hepatocellular carcinoma based on lesion size and location. Methods: Sixty patients with 88 hepatocellular carcinoma lesions that showed tumor staining on angiography and were enhanced on dynamic computed tomography were evaluated. Power Doppler sonography and color Doppler sonography were used to detect the intratumoral vasculature, and their sensitivity to blood flow was evaluated. Results: Power Doppler sonography showed a superior detection rate for lesions smaller than 2 cm and located 4–8 cm from the abdominal surface in the right hepatic lobe as compared with color Doppler sonography (p < 0.01). Neither power Doppler sonography nor color Doppler sonography depicted the intratumoral vasculature of lesions located more than 8 cm from the abdominal surface (n = 14). Both color Doppler imagings exhibited a low detection rate for lesions in the left hepatic lobe (n = 31, p < 0.01). Conclusions: Power Doppler sonography should be applied in the evaluation of small or intermediate depth lesions because it is more sensitive to these lesions than color Doppler sonography, but it is not useful for left lobe and deep lesions. Received: 31 March 1999/Accepted: 14 July 1999     

Preoperative assessment of the portal vein and hepatic artery in children with end-stage liver disease: is selective angiography still necessary?

Background: Selective angiography involves increased risk for children and may cause vascular complications. The aim of this study was to determine whether selective angiography is still necessary for viewing the portal vein and hepatic artery. Methods: Doppler ultrasound, abdominal aortography, and selective angiography were performed and interpreted independently in 62 children (median age = 1 year 3 months), with end-stage liver disease, who were candidates for orthotopic liver transplantation. Results: Selective angiography agreed with the Doppler ultrasound findings of patency, flow direction, and diameter of the extrahepatic portal vein in 84%, 73%, and 79% of the children, respectively. Important additional information was obtained from selective angiography in only five of the 62 children (8%). Selective angiography showed an anomaly of the hepatic artery in 21 of the 62 children (33%). In 18 out of these 21 children (85%), an anomaly of the hepatic artery was already visible on the abdominal aortogram. Conclusion: Selective angiography did not play any significant role in the detection of an anomaly of the hepatic artery and should only be done if the Doppler ultrasound findings of the portal vein are inconclusive or if abdominal aortography cannot provide reliable information about the hepatic artery. For the evaluation of the portal vein and hepatic artery, we recommend Doppler ultrasound and abdominal aortography, a less invasive angiographic procedure. Received: 12 May 1995/Accepted: 26 June 1995     

Focal nodular hyperplasia of the liver: serial MRI with Gd-DOTA,superparamagnetic iron oxide,and Gd-EOB-DTPA

Background: To demonstrate the improved specificity of liver MRI in diagnosis of focal nodular hyperplasia (FNH) using liver specific contrast agents. Methods: In a patient after resected adenosarcoma of the uterus a focal nodular hyperplasia was followed. Serial MRI of the liver was performed using first Gd-DOTA, followed by superparamagnetic iron oxide (SPIO) as well as Gd-EOB-DTPA. Results: During the follow-up of FNH specificity of liver MRI improved using liver specific contrast agents. The central scar as well as the pseudocapsule showed different typical contrast uptake using all three methods. Conclusion: Serial MRI of the liver with Gd-DOTA, SPIO and Gd-EOB-DTPA can exclude a malignant liver lesion. Liver biopsy of FNH can be avoided with increased specificity of MRI for FNH. Received: 15 December 1995/Accepted: 17 January 1996     

Characterization of solid liver lesions with color and pulsed Doppler imaging

Background: To assess the usefulness of color Doppler and duplex sonography in the characterization of solid liver lesions. Methods: We performed color Doppler and duplex sonography on 106 solid hepatic lesions. With color Doppler, we evaluated the aspect and distribution of tumoral vessels. The pulsed Doppler parameters considered were only those showing the highest systolic peak velocity values. Results: Intratumoral color and pulsed Doppler signals were obtained in 81% (59/73) of malignant tumors (p < 0.0001) but only in 18% (6/33) of benign tumors. Ninety-six percent (45/47) of the lesions with arterial intratumoral and peritumoral signals were malignant, whereas 4% were benign (p < 0.0001). Only eight (11%) malignant lesions had intratumoral venous signal vis-a-vis 23 (70%) benign. Twelve cases showing intratumoral venous Doppler signal as a single finding were benign. No statistically significant differences were observed in the quantitative parameters recorded by pulsed Doppler (Student t test, p < 0.05), there having been a clear overlapping in the values obtained in benign and malignant lesions. Conclusions: (a) The type of signal (arterial or venous) and its distribution detected by color and pulsed Doppler is more helpful than the assessment of the spectral quantitative parameters obtained by pulsed Doppler. (b) The presence of intratumoral venous flow remarkably suggests benignancy. (c) The presence of both intra- and peritumoral arterial flow in the same lesion strongly suggests malignancy. Received: 3 January 1997/Revision accepted: 17 December 1997     

High prevalence of hepatic focal nodular hyperplasia in subjects with hereditary hemorrhagic telangiectasia

A vascular pathogenesis of hepatic focal nodular hyperplasia (FNH) has been suggested; this study was aimed to evaluate in families with hereditary hemorrhagic telangiectasia (HHT) the prevalence of FNH, relating it to presence and stage of hepatic vascular malformations (VMs). Fifty-two HHT families underwent a screening program including abdominal Doppler sonography (US) searching for hepatic VMs; we classified them as minimal, moderate and severe, depending on the number and degree of abnormalities found by Doppler US. Presence of focal liver lesions was recorded. Diagnosis of FNH was made if at least two examinations, whether color Doppler US, liver scintigraphy, dynamic computed tomography (CT) or magnetic resonance (MR), showed suggestive findings. FNH was found in five out of 274 subjects (1.8%). All five were affected by HHT. Thus, percentage related to the group of affected patients increased to 2.9; 4/5 presented severe liver VMs. Female-to-male ratio was 4:1. FNH was single in three cases; tumor size ranged between 20 and 90 mm. During follow-up, no lesion showed a reduction in size, three showed an increase. Prevalence of FNH in patients with HHT is far greater than that reported in the general population; Doppler US role in its diagnosis and follow-up is highlighted.     

Focal nodular hyperplasia of the liver: detection and characterization with plain and dynamic-enhanced MRI

Background: We compared nonenhanced and dynamic gadolinium (Gd)–enhanced magnetic resonance imaging (MRI) appearances of hepatic focal nodular hyperplasia (FNH) as depicted with breath-hold MR sequences and assessed the detectability of the individual MR sequences used. Methods: We retrospectively reviewed 48 consecutive patients with FNH. All patients underwent nonenhanced (T1 fast low-angle shot [FLASH] and T2 half-Fourier acquisition [HASTE]) and dynamic Gd-enhanced (T1 FLASH) MRI between December 1997 and March 2000. Individual MR sequences were analyzed separately for number of lesions, signal intensity features, dynamic enhancement pattern, and the presence and enhancement profile of a central scar. Ninety-five percent confidence intervals of absolute discrepancy were calculated to define differences in lesion detection. Results: Seventy-seven lesions were found in 48 patients. Nonenhanced FLASH imaging depicted 59 (76.6%) lesions in 45 patients. HASTE images showed 55 (71.4%) lesions in 44 patients. On T1- and T2-weighted images, lesions appeared predominantly hypointense (69.5%) and hyperintense (72.7%), respectively. Arterial and portal venous dominant phase Gd-enhanced MRI demonstrated all 77 lesions (100%), most of which showed hypervascular (94.8%), homogeneous (97.4%), and incomplete (except the central scar: 58.4%) enhancement in the arterial phase. Portal venous phase images showed lesion isointensity (50.6%) or moderate hyperintensity (46.8%) with complete enhancement (central scar: 94.8%). A central scar was detected on nonenhanced T1-weighted images (hypointense: 100%), T2-weighted images (hyperintense: 100%), arterial phase (hypointense: 59.7%) and portal venous phase (hyperintense: 71.4%) Gd-enhanced images in 78%, 69.1%, 77.9%, and 75.3% of tumors, respectively. Conclusion: Arterial and portal venous phase Gd-enhanced T1-weighted sequences are superior to nonenhanced images in the detection of FNH. Typical MRI appearances include hypointensity on T1-weighted and hyperintensity on nonenhanced T2-weighted images. Most commonly, FNH shows a homogeneous (without scar) and strong enhancement during the arterial phase, with lesion isointensity or slight hyperintensity during the portal venous phase. Received: 15 May 2001/Revision accepted: 22 August 2001     

肝脏局灶性结节性增生的超声诊断

目的　探讨超声对肝脏局灶性结节性增生(FNH)的诊断价值。方法　对10例共10个手术及病理证实的FNH进行超声分析。结果　FNH在常规B超上多表现为低回声及均匀的实质回声,偶见低回声的星状疤痕,但总体上缺乏较特异的声像图表现;而彩色多普勒可显示一粗大的彩色血流伸入病灶中央并分支,显示率为70%,部分呈轮辐状排列(20%),有一定的特征。结论　彩色多普勒结合常规B超可提高超声对FNH诊断的准确性     

Intrahepatic venous collaterals

Background: The aim of this study was to reevaluate the causes and sites of intrahepatic venous collaterals and to determine the role of color Doppler sonography in the diagnosis of this relatively rare vascular abnormality. Methods: Real-time color Doppler sonography was used to study 21 patients with intrahepatic venous collaterals. The cause, distribution, and clinical manifestations of collaterals were determined, and Doppler waveforms obtained from the collaterals were also analyzed. Results: First, the causes of intrahepatic venous collaterals were divided roughly into two groups according to the presence or absence of veno-occlusions. The former group included liver tumors (six cases), primary Budd-Chiari syndrome (five cases), and metastatic adrenal tumors invading the inferior vena cava (two cases). The latter group consisted of diaphragmatic hernia (three cases), Osler-Weber-Rendu disease (two cases), and congestive liver (one case). The cause was not determined in two cases. Second, venous collaterals were distributed throughout the entire liver in primary Budd-Chiari syndrome but localized in the other cases. Third, Doppler waveforms of the collaterals were divided into two patterns: flat flow and multiphasic flow. Flat flow pattern was seen in patients with veno-occlusive diseases, and multiphasic flow pattern was seen in patients without veno-occlusive disease. Conclusion: The relationship between intrahepatic venous collaterals and veno-occlusive diseases has been emphasized in the literature, but the results of our series showed that they occurred under a wide variety of conditions, even without veno-occlusive diseases, including diaphragmatic hernia and Osler-Weber-Rendu disease. The analysis of the Doppler waveforms of the collaterals was useful in differentiating those due to veno-occlusive diseases and those not. Received: 13 December 1996/Accepted: 22 January 1997     

Fascioliasis: US, CT, and MRI findings with new observations

Background: The purpose of this study is to describe the ultrasonographic (US), computed tomographic (CT), and magnetic resonance imaging (MRI) findings in fascioliasis and to emphasize the impact of radiology in diagnosis. Methods: Radiologic findings in 23 consecutive patients with fascioliasis were prospectively recorded. All patients had at least one US and CT examination, and 10 of them were studied by MRI. All diagnoses were confirmed by serologic methods. In the first three cases, initial diagnosis was reached by microscopic demonstration of the parasites' eggs in bile obtained by US-guided gallbladder aspiration. Results: In the hepatic phase of fascioliasis, multiple, confluent, linear, tractlike, hypodense, nonenhancing hepatic lesions were detected by CT. On US, the parasites could be clearly identified in the gallbladder or common bile duct as floating and nonshadowing echogenic particles. MRI showed the lesions as hypo- or isointense on T1-weighted images and as hyperintense on T2-weighted images. Conclusions: CT findings in the hepatic phase and US findings in the biliary phase are characteristic of fascioliasis. Because clinical and laboratory findings of fascioliasis may easily be confused with several diseases, radiologists should be familiar with the specific radiologic findings of the disease to shorten the usual long-lasting diagnostic process. Received: 15 December 1999/Accepted: 26 January 2000     

Chronic tuberculous epididymitis: color Doppler US findings with histopathologic correlation

BACKGROUND: The aim of this study was to determine the color Doppler features of tuberculous epididymitis and to correlate these findings with histopathologic findings. METHODS: Color Doppler ultrasound (US) findings of 12 histopathologically proven tuberculous epididymitis and tuberculous epididymo-orchitis in 11 consecutive patients were retrospectively analyzed. Color Doppler US findings of tuberculous epididymitis were correlated with histopathologic findings. RESULTS: Color Doppler US findings of tuberculous epididymitis demonstrated no blood flow in the epididymal lesions except for focal linear or spotty flow signals in the peripheral portion. These findings correlated well with pathologic findings; the central portion of the epididymal lesions demonstrated granulomas with caseation necrosis, and the peripheral portion of the epididymal lesions had several medium to small vessels. CONCLUSIONS: Color Doppler US may be helpful for differential diagnosis of tuberculous epididymitis and non-tuberculous epididymitis.     

Choledochal cyst due to anomalous pancreatobiliary junction in the adult: sonographic findings

Background: Adult cases of choledochal cyst due to anomalous pancreaticobiliary duct junction have been rarely reported. At present, sonography (US) is the first tool for diagnosing biliary disorders. The aim of this study was to reevaluate the US findings of choledochal cysts due to anomalous pancreaticobiliary duct junction in adults. Methods: We reviewed the clinical manifestations and US findings of 12 such adult cases confirmed by endoscopic retrograde cholangiopancreatic ductography (ERCP). Patients were assigned to three groups: (a) associated with biliary carcinoma (two cases), (b) associated with choledocholithiasis (one case), and (c) not associated with other abdominal diseases (nine cases). Results: Patients in group c were asymptomatic, and the lesions were detected incidentally detected by US. In contrast, patients in group a sought medical care because of symptoms such as jaundice and those in group b sought medical attention because of abdominal pain. The diameter of a dilated bile duct on US was considerably less than that of ERCP (ERCP: 26–58 mm, mean = 37.6 mm; US: 13–32 mm, mean = 21.8 mm). Its diameter changed significantly under probe compression when the dilated bile duct took a purely cystic form but changed very little when it took a tubular form. Conclusion: Unlike cases in children, adult cases of choledochal cyst are generally asymptomatic. Careful US observation of the bile duct is thus expected to detect asymptomatic adult choledochal cysts cases. Cyst diameter can change significantly under probe compression, so it is important not to compress the bile duct during routine US examination. Received: 13 September 2000/Accepted: 18 October 2000     

Dilatation of the cystic duct in patients with obstructive jaundice

Background: It is well known that obstructive jaundice causes biliary dilatation, but sonographic (US) findings of the cystic duct in patients with obstructive jaundice are rarely reported. Methods: We reviewed US findings in 25 such patients. Results: US findings of dilated cystic duct could be divided roughly into two patterns: tortuous and tubular. The former pattern was a tortuously dilated cystic duct arising from the gallbladder neck, running predominantly deeply, turning anteromedially, and then joining the posterior face of the common hepatic duct. The latter pattern was a straight dilated cystic duct running parallel with the common hepatic duct, giving the appearance of a septated bile duct. Conclusion: A better understanding of the US findings of dilated cystic duct translates into improved biliary US diagnosis.     

Hepatic focal nodular hyperplasia: findings with color Doppler sonography

Color Doppler sonographic images of five patients with a total of six lesions of FNH were reviewed. All cases were confirmed pathologically. All six lesions showed increased intralesional flow in comparison to surrounding liver parenchyma on color Doppler sonography. Four of the six lesions showed significant peripheral flow; two of the six lesions showed central flow radiating peripherally from a central vessel. We conclude that increased color Doppler flow may be a characteristic feature of FNH. Increased internal flow has also been reported in HCC and hepatic metastatic disease. Considerable overlap is seen in color Doppler flow patterns. However, in patients clinically at low risk for malignancy, detection of a liver mass with increased color Doppler flow should suggest the diagnosis of FNH.