Direct infusion of EOE-13 into the hepatic artery. Experimental evaluation of safety in monkeys

Ethiodized Oil Emulsion 13 (EOE-13) is an intravenous liver-spleen specific CT contrast agent. We infused EOE-13 directly into the hepatic arteries of five rhesus monkeys. Normal saline was administered in the same fashion in two control animals. Serial laboratory studies showed no major toxicity over a seven-day period. Intra-arterial EOE-13 has potential usefulness in the evaluation of hepatic artery infusion chemotherapy.     

Intraarterial administration of EOE-13 for the CT evaluation of hepatic artery infusion chemotherapy

EOE-13 was infused directly into the hepatic artery through a surgically implanted hepatic artery infusion pump in a patient with liver metastases. A computed tomographic scan obtained after EOE-13 infusion accurately showed the perfusion pattern of the implanted catheter. It also demonstrated the hepatic metastases more clearly than scintigraphy with 99mTc-macroaggregated albumin. EOE-13 may prove useful for the evaluation of hepatic perfusion patterns in patients receiving hepatic artery infusion chemotherapy.     

CT evaluation of limited splenic trauma

One case is reported in which signs of limited splenic injuries were seen on initial CT evaluation. Delayed splenic rupture requiring splenectomy was observed by CT. These previously unreported signs of limited splenic trauma may add important management information to the current methods of diagnosing splenic injury.     

Experimental comparison of EOE-13 and perfluoroctylbromide for the CT detection of hepatic metastases

The relative advantages of EOE-13 and perfluoroctylbromide (PFOB) as contrast agents were evaluated using CT scanning in animals with implanted liver tumors. Three criteria were used to compare these compounds: (1)the density difference between liver and tumor, (2)the presence of opacification of intrahepatic vascular structures, and (3)the presence of ring enhancement around the tumors. All three radiographic features were superior in the scans after injection of 5 g/kg of PFOB. When a reduced dose (1.7 g/kg) of PFOB was used, however, the scans obtained with EOE-13 were of approximately equal quality. It is concluded that if toxicity problems prevent administration of PFOB in humans, then EOE-13 will probably remain the contrast agent of choice for tumor imaging in the liver.     

Assessment of perfusion patterns during hepatic artery infusion chemotherapy: EOE-13 CT and 99mTc-MAA scintigraphy

Hepatic perfusion patterns were evaluated in five patients receiving hepatic artery infusion chemotherapy. All patients underwent 99mTc macroaggregated albumin (99mTc-MAA) scintigraphy and CT with EOE-13. In each case, the diagnostic agent was administered through the infusion catheter at 0.66 ml/min. Hepatic perfusion patterns were identified with both imaging methods, but CT with EOE-13 yielded more precise anatomic detail and was unique in demonstrating the perfusion status of each hepatic metastasis. Further evaluation of EOE-13 for this purpose is warranted.     

CT of the liver and spleen with EOE-13: review of 225 examinations

EOE-13 is an experimental liver-spleen-specific computed tomographic (CT) contrast agent developed at the National Institutes of Health. Experience with this agent in 225 clinical examinations is described. On average, use of EOE-13 increases the attenuation of normal liver by 32.5 H and that of normal spleen by 52.3 H. Tumors in these organs increase only 2.6 H, making them more easily detectable. Most of the iodine in EOE-13 appears to clear from the liver and spleen by 24 hr after injection. No deaths or permanent morbidity have been observed. The complication rate is 3.6%. EOE-13 is valuable for the detection of hepatic and splenic tumors.     

CT evaluation of hepatic paragonimiasis with simultaneous duodenal or splenic involvement

Paragonimiasis is a parasitic infection caused by the genus Paragonimus and usually leads to pulmonary disease. Hepatic paragonimiasis is rare, but duodenal and splenic involvement of this disease has not yet been reported in the literature. Herein, we report two rare cases of hepatic paragonimiasis with simultaneous duodenal or splenic involvement, respectively, and described their CT features. Both patients were lifelong residents of an endemic area of paragonimiasis and were confirmed clinicopathologically.     

钝性脾损伤的CT诊断

目的探讨CT非增强扫描对钝性脾损伤的诊断价值。方法回顾性分析经CT非增强扫描并经手术及临床确诊的41例钝性脾损伤。结果脾脏包膜下血肿12例,脾内血肿16例,脾撕裂伤19例,脾粉碎8例,伴有腹腔积血30例。无假阳性,3例假阴性,CT非增强扫描诊断脾损伤敏感性92.7%,特异性100%,准确率92.7%。结论CT非增强扫描能够较好的显示钝性脾脏损伤的表现,为临床治疗提供可靠依据。     

Proximal versus peripheral hepatic artery embolization experimental study in monkeys.

A case is described in which extensive embolization of the hepatic artery to reduce insulin production by a metastatic islet-cell tumor resulted in liver failure, intrahepatic abscesses, and death. The difference between proximal and peripheral hepatic artery obstruction was investigated in monkeys by embolizing hepatic arterial beds with Gelfoam and silicone. Gelfoam obstructed proximally, arterial collaterals developed rapidly, and liver function remained normal. Peripheral hepatic artery embolization with silicone produced liver infarction and severe functional abnormalities. Peripheral hepatic artery occlusion was more effective in preventing the development of collateral circulation but involved a significant risk of hepatic failure or abscess.     

CT findings in hepatic and splenic amyloidosis

In a patient with biopsy proven focal amyloidosis of the liver CT showed a uniform decrease in attenuation, with a focal large low-density lesion in the right hepatic lobe. Following intravenous contrast medium injection, there was poor contrast enhancement.     

EOE-13 in the detection of hepatosplenic lymphoma

Thirty-nine patients with lymphoma were evaluated prospectively to determine the usefulness of Ethiodol-Oil-Emulsion-13 (EOE-13) in the detection of hepatosplenic lymphoma by computed tomography. The detection rate in the spleen increased from 8% (before EOE-13 infusion) to 92% (after EOE-13 infusion). In ten of 39 patients (25%) in this series, lymphomatous disease was recognized only on the postinfusion computed tomographic scan. The postinfusion EOE-13 study demonstrated additional visceral abnormalities in 38% of the patients. The potential usefulness, limitations, and toxicity of this hepatosplenic-specific imaging agent are discussed.     

Echographic evaluation of splenic injury after blunt trauma.

In a significant number of patients with blunt abdominal trauma, the diagnosis of ruptured spleen is not readily apparent. Is is in these cases that echographic evaluation appears to aid significantly in diagnosis. Seventy patients with blunt abdominal trauma were studied by echography. Results indicated 61 true negative cases, 1 false negative, 4 true positives, and 4 false positives. Criteria for splenic rutures are set forth. Ultrasound is considered to be an excellent screening procedure for suspected splenic rupture.     

Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma

Purpose

The aim of this study was to evaluate contrast-enhanced ultrasound (CEUS) imaging of active bleeding from hepatic and splenic trauma.

Materials and methods

Three hundred and ninety-two patients with liver or/and spleen trauma (179 liver and 217 spleen injuries), who underwent CEUS examinations following contrast-enhanced computed tomography (CT), were enrolled in this retrospective study over a period of >4 years. CEUS detected contrast medium extravasation or pooling in 16% (63/396) of liver or spleen lesions in 61 patients, which was confirmed by contrast-enhanced CT. Special attention was paid to observing the presence, location, and characteristics of the extravasated or pooled contrast medium.

Results

The CEUS detection rate for active bleeding was not different from that of contrast-enhanced CT (p=0.333). Information from surgery, minimally invasive treatment and conservative treatment was used as reference standard, and the sensitivities of the two techniques were not different (p=0.122). Of 63 lesions in 61 patients, CEUS showed that 74.6% (47/63) (21 liver lesions and 26 spleen lesions) presented contrast medium extravasation or pooling, both in the organ and out the capsule, in 14.3% (9/63) and only outside the capsule in 11.1% (7/63). CEUS imaging of active bleeding from hepatic and splenic trauma presented various characteristics, and the sizes and shapes of the active bleeding due to contrast medium extravasation or pooling were variable.

Conclusions

CEUS can show the active bleeding associated with hepatic and splenic trauma with various imaging characteristics, thus making it possible to diagnose active bleeding using CEUS.     

Solid splenic masses: evaluation with 18F-FDG PET/CT.

Our objective was to assess the role of (18)F-FDG PET/CT in the evaluation of solid splenic masses in patients with a known malignancy and in incidentally found lesions in patients without known malignancy. METHODS: Two groups of patients were assessed: (a) 68 patients with known malignancy and a focal lesion on PET or a solid mass on CT portions of the PET/CT study; and (b) 20 patients with solid splenic masses on conventional imaging without known malignancy. The standard of reference was histology (n = 16) or imaging and clinical follow-up (n = 72). The lesion size, the presence of a single versus multiple splenic lesions, and the intensity of (18)F-FDG uptake expressed as a standardized uptake value (SUV) were recorded. The ratio of the SUV in the splenic lesion to the background normal splenic uptake was also calculated. These parameters were compared between benign and malignant lesions within each of the 2 groups of patients and between the 2 groups. RESULTS: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of (18)F-FDG PET/CT in differentiating benign from malignant solid splenic lesions in patients with and without malignant disease were 100%, 100%, 100%, and 100% versus 100%, 83%, 80%, and 100%, respectively. In patients with known malignant disease, an SUV threshold of 2.3 correctly differentiated benign from malignant lesions with the sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%, respectively. In patients without known malignant disease, false-positive results were due to granulomatous diseases (n = 2). CONCLUSION: (18)F-FDG PET can reliably discriminate between benign and malignant solid splenic masses in patients with known (18)F-FDG-avid malignancy. It also appears to have a high NPV in patients with solid splenic masses, without known malignant disease. (18)F-FDG-avid splenic masses in patients without a known malignancy should be further evaluated as, in our series, 80% of them were malignant.     

Quantitative diagnosis of fatty liver with dual-energy CT. An experimental study in rabbits

OBJECTIVES: To explore the correlation between fatty content of fatty liver and the difference of CT attenuation value in dual-energy CT, and to evaluate the value of dual-energy CT in the quantitative diagnosis of fatty liver in rabbits. MATERIAL AND METHODS: Dual-energy CT at 120 kVp and 90 kVp was performed in 16 rabbits of experimental groups that were induced to various degrees of fatty liver by feeding carbon tetrachloride (CCl4). Four healthy rabbits in the control group underwent dual-energy CT at the same time. The CT attenuation values of liver tissues at 120 kVp (H120), 90 kVp (H90) and the difference (Delta H) between them were obtained. The specimens of liver tissues were examined with freeze section (9 microm) and an oil red O stain histologically. The ratio of fatty content in liver to the liver volume (VP value) was measured using the image analyzer system. RESULTS: The change of CT attenuation values between 120 kVp and 90 kVp was not obvious (Delta H between -0.4 HU and 1.4 HU) in the control group. The density of the liver in the experimental groups decreased differently, and the change in CT attenuation values between high and low energy levels were very clear. H120 values were between 51.0 HU and 91.7 HU and H90 values were between 37.0 HU and 89.2 HU. Delta H values were between 2.5 HU and 14.0 HU. Significant negative linear correlation (r = -0.92, -0.93, t = 8.51, 9.76, p < 0.001, 0.001, respectively) were found between VP values and H120 and H90, respectively, while significant positive linear correlation (r = 0.95, t = 11.89, p < 0.001) was found between VP values and Delta H. CONCLUSION: The amount and degree of fat in the fatty liver can be assessed exactly by dual-energy CT. It will be a potential new effective method for quantitative diagnosis of fatty livers.     

CT evaluation of hip trauma

Selection of treatment for fracture dislocations about the hip is based on the stability of the joint space, congruity of fracture fragments, the presence or absence of intraarticular fragments, and the overall condition of the patient. However, the condition of the acetabulum, femoral head, and joint space is frequently difficult to evaluate on conventional radiographs of the pelvis. To provide the orthopedist with more information on which to base treatment, 13 patients had computed tomography (CT) after accidents resulting in trauma to the hip and pelvis. The CT scan was believed to have significantly influenced the treatment in four of the patients and provided useful information in several others. CT was found to be helpful especially for evaluating presence or absence of intraarticular osseous loose fragments after reduction of the dislocated hip for evaluating congruity of the joint space after fractures of the femoral head and acetabulum. CT also provided useful information concerning the adjacent soft tissues and associated pelvic fractures.