Childhood hepatocellular carcinoma and hepatoblastoma: integrated sonography and dynamic CT.

13 cases of hepatoblastoma and hepatocellular carcinoma are reviewed with respect to the visibility of the tumour margin, hepatic veins, and portal veins on non-contrast, non-dynamic and dynamic computerised scans. In large tumours the accurate interpretation of venous anatomy can be difficult. We found that dynamic scanning followed by a repeat scan of selected slices after a few minutes was the most useful method. If facilities for dynamic scanning are not available then it is suggested that conventional scanning be performed immediately after the intravenous injection so as to avoid the isodense phase of hepatic enhancement.     

Abdominal sonography after hepatic transplantation: results in 36 patients

Hepatic transplantation was performed in 46 patients over a 2-year period at the University of Minnesota. Thirty-six of these patients subsequently underwent 166 sonographic examinations of the upper abdomen. Forty-three examinations were performed within 2 weeks of transplantation, 47 between 2 and 8 weeks after transplantation, and 76 more than 8 weeks after transplantation. The sonograms were reviewed retrospectively and correlated with the available clinical and histopathologic data. Diffuse, nonspecific parenchymal abnormalities were seen in 27 patients. Focal regions of parenchymal abnormality seen in four patients were associated with abscess and infarction. Moderate to severe biliary dilatation was seen in seven patients with biliary obstruction diagnosed by percutaneous or T-tube cholangiography. Obstruction was seen most commonly in children who had undergone cholecystojejunostomy biliary reconstruction, and it required radiologic or surgical intervention. Routine sonographic assessment of the upper abdominal vasculature showed thrombosis of the portal vein in two cases, thrombosis of the inferior vena cava in one case, thrombosis of the donor aorta in three cases. Focal intraabdominal fluid collections were identified in 14 patients and represented hematomas in all but one. Free peritoneal fluid was detected in 19 patients. Sonography was used to guide percutaneous aspiration of abdominal fluid and to guide fine-needle puncture for percutaneous transhepatic cholangiography. Upper abdominal sonography provides a noninvasive means of evaluating and confirming a wide spectrum of complications that can follow hepatic transplantation. Because clinical and laboratory findings often are nonspecific in these patients, sonographic detection of focal parenchymal abnormalities, biliary dilatation, and vascular compromise is especially valuable.     

螺旋CT多期增强扫描对平扫为等密度的肝细胞癌的诊断

目的 分析平扫为等密度的肝细胞癌(hepatocellular carcinoma,HCC)的螺旋CT( spiral CT,SCT)多期增强扫描表现,探讨SCT多期增强扫描对此类HCC的诊断价值.方法 收集本院经手术病理、肝穿刺活检或临床随访证实的CT平扫呈等密度的HCC 14例(占同期702例HCC的1.99%),回顾性分析这类HCC 的SCT多期增强扫描的强化方式及CT征象.结果 14例HCC 的SCT平扫均呈等密度影(假阴性).SCT多期增强扫描表现为"速升速降"型强化的4例,3例可见肿瘤假包膜形成;动脉期仍为等密度,门脉期及延迟期呈低密度影的4例;动脉期、门脉期和延迟期癌灶均呈低密度影的2例;动脉期瘤灶明显强化,门脉期、延迟期表现为等密度的3例;平扫为等密度、多期增强扫描显示动静脉瘘及门静脉癌栓的弥漫型肝细胞癌1例.结论 CT平扫可能会漏诊等密度的肝癌病灶,可疑患者需行增强扫描检查;SCT多期增强扫描能显示平扫为等密度的HCC的血供特点,对其具有重要的诊断价值.     

Poor sensitivity of sonography in detection of hepatocellular carcinoma in advanced liver cirrhosis: accuracy of pretransplantation sonography in 118 patients

The objective of this study was to assess the detectability of hepatocellular carcinoma by sonography in advanced cirrhotic patients undergoing liver transplantation. We retrospectively reviewed pretransplantation sonography in 118 consecutive patients with advanced liver cirrhosis. We assessed the detectability of hepatocellular carcinoma in relation to tumor size, location, total liver volume, and degree of sonographic heterogeneity of the liver parenchyma. On pathologic examination, 51 hepatocellular carcinomas were identified in 31 patients. Pretransplantation sonography depicted 14 of 51 (27%) hepatocellular carcinomas. Detectability was significantly affected according to tumor size (p=0.0099), but there was no significant difference according to tumor location, liver volume, or degree of sonographic heterogeneity of the liver parenchyma. Our study suggests that sonography is not sufficiently sensitive to detect hepatocellular carcinoma in patients with advanced liver cirrhosis. Tumor size is the only factor influencing the detectability of hepatocellular carcinoma.     

Pretransplantation diagnosis and staging of hepatocellular carcinoma in patients with cirrhosis: value of dual-phase helical CT

OBJECTIVE: The objective of our study was to prospectively evaluate the results of helical CT in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis undergoing orthotopic liver transplantation. SUBJECTS AND METHODS. Eighty-five patients with cirrhosis were studied preoperatively with biphasic helical CT. Arterial, portal, and equilibrium phase images were obtained after injection of 170 mL of contrast material at 5 mL/sec. The prospective CT interpretation was compared with pathologic results on a lesion-by-lesion basis. RESULTS: Pathologic examination found 85 cases of HCC in 51 patients. Helical CT enabled a correct diagnosis of HCC in 67 of 85 lesions for a sensitivity of 78.8%. HCC nodules were hypervascular in the arterial phase and hypovascular in the equilibrium phase in 63.5% (54/85) of patients. The false-negative rate was 21% (n = 18), and the positive predictive value was 88%. We had nine false-positive findings (11.8%) related to hemangiomas, transient hepatic attenuation differences, and regenerative nodules. Helical CT detected 61% (23/38) of lesions smaller than 2 cm and 93.6% (44/47) of lesions 2 cm or larger. CONCLUSION: Helical CT is a useful preoperative imaging technique in cirrhotic patients who are candidates for orthotopic liver transplantation, although it is relatively insensitive for detection of small lesions (< 2 cm).     

Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation

Objective

The aim of this study was to determine the effectiveness and safety of percutaneous laser ablation for the treatment of cirrhotic patients with hepatocellular carcinoma awaiting liver transplantation.

Materials and methods

The data of 9 male cirrhotic patients (mean age 50 years, range 45-60 years) with 12 biopsy proven nodules of hepatocellular carcinoma (mean diameter 2.0 cm, range 1.0-3.0 cm) treated by laser ablation before liver transplantation between June 2000 and January 2006 were retrospectively reviewed. Laser ablation was carried out by inserting 300 nm optical fibers through 21-Gauge needles (from two to four) positioned under ultrasound guidance into the target lesions. A continuous wave Neodymium:Yttrium Aluminium Garnet laser was used. Transarterial chemoembolization prior to liver transplantation was performed in two incompletely ablated tumors.

Results

No procedure-related major complications were recorded. During the waiting time to liver transplantation local tumor progression after ablation occurred in 3 nodules (25%). At histological examination of the explanted livers complete necrosis was found in 8 nodules (66.7%, all treated exclusively with laser ablation), partial necrosis >50% in 3 nodules (25%), and partial necrosis <50% in 1 nodule.

Conclusion

In patients with cirrhotic livers awaiting liver transplantation, percutaneous laser ablation is safe and effective for the management of small hepatocellular carcinoma.     

Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT

We compared the results of endoscopic sonography and CT in the preoperative staging of 46 patients with esophageal carcinoma studied prospectively. All patients had surgery and 44 had pathologic examination of the mediastinal and celiac lymph nodes. The results of CT and endoscopic sonography were compared with surgical and pathologic findings. A total of 51 tumors were found in 46 patients. Sonographic estimation of tumor extension through the different layers of the esophagus was correct in 37 (73%) of all 51 tumors and in 22 (85%) of the 26 tumors in which the examination was complete. The echoendoscope (13-mm diameter) could not pass through the tumor in 23 cases (50%). Infiltration to adjacent organs was found in 15 cases at surgery. In four of these 15, the extension was detected by CT; in seven of the 15 cases, it was detected by sonography. False-negative determination of tumor extension occurred with endoscopic sonography in patients with stenotic tumor. There were no false-positive results with either CT or endoscopic sonography. For detection of mediastinal lymph-node involvement, the sensitivity of CT was 48%. The sensitivity of sonography was 50% if metastatic nodes unexplored by sonography were included, or 84% if only cases in which stenosis was passed were considered. Statistical comparison revealed that sonography was superior to CT for the detection of metastases to lymph nodes. CT and endoscopic sonography provide complementary information. When the echoendoscope can be maneuvered past the tumor, sonography can be used accurately to define extension through the layers of the esophagus, extension to the adjacent organs, and involvement of the lymph nodes. When the tumor cannot be passed by the echoendoscope, CT is superior to sonography for detection of mediastinal extension.     

Renal imaging in long-term dialysis patients: a comparison of CT and sonography

Patients undergoing long-term dialysis are subject to cyst formation, hemorrhage, and neoplasia in their native kidneys. Detection of these complications with incremental dynamic CT and detection with sonography were compared prospectively in 41 patients (79 kidneys) who had been undergoing dialysis intermittently for 3 or more years. Acquired cystic kidney disease (five or more cysts per kidney) was identified in 59% of kidneys by use of CT and in 18% by use of sonography. CT showed a complete renal contour definition in all cases, sonography did so in only 57%. Three solid renal tumors (2- to 4-cm diameter) were identified with both techniques with no false-negative evaluations. Four benign hemorrhagic cysts were identified with combined CT (hyperdense mass) and sonography (benign cysts). CT provided the best anatomic image quality and was more accurate for detection of acquired cystic kidney disease. CT and sonography were equivalent for detection of solid tumors. Our results suggest that dynamic contrast-enhanced CT scanning with the supplemental use of sonography is the best imaging regimen for the evaluation of suspected acquired cystic kidney disease and its potential complications.     

Hepatic artery pseudoaneurysms in adult living-donor liver transplantation: efficacy of CT and Doppler sonography

OBJECTIVE: The purpose of this study was to evaluate the efficacy of contrast-enhanced CT and Doppler sonography in the diagnosis of hepatic artery pseudoaneurysm after adult living-donor liver transplantation (LDLT). CONCLUSION: Because patients with hepatic artery pseudoaneurysm after LDLT can have diverse clinical presentations, routine imaging follow-up is important for early detection. Although Doppler sonography is limited in showing the pseudoaneurysm, contrast-enhanced CT, especially MDCT with CT arteriography, is effective in showing it in most patients.     

肝硬化结节与小肝癌的CT、MRI诊断

在肝硬化结节及小肝癌的早期诊断方面,CT、MRI仍是目前临床工作中最重要的方法,本文阐述肝硬化结节演变为肝癌过程中的几个重要环节的CT、MRI表现及国内、外对此的研究现状,这几个环节包括肝硬化再生结节、发育不良性结节(低、中、高级)、小肝癌及肝癌,它们在CT、MRI表现上各有特征,但相互间也有影像学表现上的重叠,故多数较典型者可以通过CT密度值、MRI信号值及增强表现判断其性质,少部分诊断有困难的病灶可以通过双动脉期扫描、MR菲立磁增强及灌注成像等方法提供更多的诊断信息。     

CT影像组学模型预测肝移植术后肝癌早期复发的价值

 目的 探索基于CT影像组学技术构建的模型在预测肝细胞癌患者肝移植术后早期复发的价值。方法 回顾性分析接受肝移植治疗的131例肝癌患者,随机分为训练组(92例)和验证组(39例),术后定期随访,了解是否发生早期复发。通过逐层勾画肿瘤边缘对肿瘤进行三维分割并进行特征提取,共提取1218个影像组学特征。具有潜在预测价值特征的筛选选用LASSO算法。基于筛选出的特征,logistic回归应用于肝移植术后预测模型的构建。通过曲线下面积(area under the curve, AUC)对模型预测患者是否会早期复发的效能进行评价。结果 筛选出8个具有潜在预测价值的特征,预测模型在训练组中AUC为0.828,敏感度、特异度分别为82.4%、74.7%;在验证组中AUC为0.856,敏感度、特异度分别为77.8%、86.7%。结论 术前增强CT影像组学技术构建的模型,对预测肝癌肝移植术后复发具有一定价值。     

Imaging diagnosis of hepatocellular carcinoma. Addendum to hepatocellular carcinoma: diagnosis, staging and treatment strategies

This addendum is aimed to review and discuss the updated non-invasive diagnostic algorithm recently published by the American Association for the Study of Liver Diseases (AASLD).     

Cystic hepatocellular carcinoma: CT findings.

Although hepatic lesions can be well characterized by noninvasive imaging modalities, findings are often nonspecific. Considerable diagnostic differential exists even for cystic hepatic lesions. We describe a highly unusual case of multifocal, multilocular cystic hepatocellular carcinoma.     

喉癌的CT诊断36例报告

CT扫描在喉癌诊断中的应用价值已被肯定,但目前文献上对喉癌的CT表现描述较少。本文就36例经病理证实的喉癌CT图像进行回顾性分析,以期找出喉癌的CT表现特征。