Study on hepatocelluar carcinoma-associated hepatic arteriovenous slunt using multidetector CT

AIM: TO investigate multidetector CT (MDCT) findings of hepatocelluar carcinoma (HCC)- associated hepatic arteriovenous shunt (HAVS) and to evaluate their clinical significance.METHODS: Thin-slice and dynamic enhancement MDCT of HAVS was performed on 56 patients with HCC. MDCT findings, including those of portal veins, hepatic veins,superior mesenteric veins, splenic veins, HCC foci, liver parenchyma without HCC foci, spleens, and thromboses in portal veins and hepatic veins, were all confirmed by digital subtract angiography and analyzed.RESULTS: MDCT demonstrated earlier enhancement of main portal trunks and/or the first order branches than that of superior mesenteric veins or splenic veins (n=31). One patient had strong early enhancement of left hepatic vein with thromboses in left hepatic vein and upper part of inferior vena cava and 1 patient had transient patchy enhancement peripheral to HCC foci in late hepatic arterial phase among them. It demonstrated stronger opacification of main portal trunks and/or the first order branches than that of superior mesenteric veins or splenic veins (n=18), and earlier enhancement of the second order and smaller branches of portal veins than that of main portal trunks (n=4), stronger opacification of the second order and smaller branches of portal veins than that of main portal trunks (n=3), with transient patchy enhancement (n=3) or wedge-shaped enhancement (n=4) peripheral to HCC foci in late hepatic arterial phase. Enhancement degree of HCC foci was all decreased. As for 49 patients with severe or moderate shunts, enhancement degree of liver parenchyma without HCC foci was increased with heterogeneous density, but enhancement degree of spleens was decreased. There were thromboses in main portal trunks and/or the first order branches in 32 patients.CONCLUSION: The main MDCT findings of HCC-associated HAVS are earlier enhancement and stronger opacification of portal veins and/or hepatic veins. Understanding of these findings will contribute to the diagnosis and prognosis of the disease and improve therapy for the patients.     

Capability of multidetector CT to diagnose hepatocellular carcinoma-associated arterioportal shunt

AIM: To investigate the capability of multidetector CT (MDCT) to diagnose HCC-associated arterioportal shunt (APS). METHODS: Two hundred and eighty-two patients with HCC received both thin-slice and enhancement MDCT scanning at early hepatic arterial phase, late hepatic arterial phase and portal venous phase, and digital subtract angiography (DSA) examination. Images were analyzed jointly by two experienced radiologists blinded to the opposite examination results, including the existence or not of APS, shunt locations, types and degrees of APS, with or without thrombosis. RESULTS: There were 56 APS associated with HCC, including 48 central, seven peripheral and one mixed, or 42 severe, seven moderate, seven mild APS. Forty-one severe, seven moderate and central APS were all revealed with MDCT and DSA. Seven mild and peripheral APS were all displayed with MDCT; only five of them displayed DSA, two faint shunt APS associated with massive HCC were missed. One mixed APS was demonstrated as severe combined with mild shunt with both MDCT and DSA. CONCLUSION: MDCT could diagnose not only DSA revealed APS, but also missed mild and peripheral APS with DSA due to faint shunt associated with massive HCC, is a simple, effective and noninvasive new technique for diagnosis of HCC-associated APS.     

小肝癌多排螺旋计算机X线体层扫描多期扫描价值的探讨

目的 评价多排螺旋CT多期扫描对小肝癌的诊断与检出。方法 75例小肝癌患者,采用MarconiMX8000CT扫描机,动脉早期的延迟时间为21s,动脉晚期延迟时间为34s,门静脉期为80s,每次全肝扫描的时间为6s。结果 71个病灶在动脉早期与动脉晚期及动脉早期与门静脉期肝癌与肝脏密度值差值有显著性(F=3.327,P<0.05)。91个病灶检出率动脉早期低于动脉晚期,分别为45.1％和83.5％,双动脉期对小肝癌的检出率为92.3％。动脉晚期加门静脉期检出率为94.5％,双动脉期加门静脉期检出率97.8％,两者差异无显著性。结论 多排螺旋CT肝脏快速、薄层、多期扫描,使富血供的肝癌得以检出的机会增加。     

肝细胞癌动静脉分流的多层CT表现及临床意义

肝动静脉分流（HAVS）包括肝动脉门静脉分流（HAPVS）和肝动脉肝静脉分流（HAHVS）。本研究旨在探讨肝细胞癌（HCC）合并HAVS的多层CT（MDCT）表现，并主人其临床意义。     

Application of ultrasonography in the diagnosis and treatment tracing of hepatocellular carcinoma-associated arteriovenous fistulas.

OBJECTIVE: Hepatic arteriovenous fistula (HAVF) can be caused by trauma, hepatic biopsy, bile duct radiology, etc. Small intrahepatic HAVF can be found in lesions of carcinoma and hepatocirrhosis. Accurate detection of HAVF was magnitude in the process to take appropriate treatment in clinic. The aim of this article is to evaluate the imaging diagnostic value on HAVF and to study the imaging character of HAVF in patients with hepatocellular carcinoma (HCC), and to evaluate the role of ultrasonographic and radiological techniques in the diagnosis and management of developmental intrahepatic shunts so as to assess the imaging diagnostic evaluation in a follow-up study. METHODS: Seventy-eight patients diagnosed with HCC were enrolled in this study, and retrospective analysis of ultrasonographic and radiological data was carried out on all 78 patients, and 25 patients suspected of having HAVF were selected. The results from ultrasonography were compared with that from digital subtraction angiography (DSA) as a gold standard. The portal and hepatic veins, hepatic arteries and vessels around and inside the tumour patients were detected and the haemodynamic indices were recorded with ultrasonography. Ten patients with HAVF were followed up after the therapy of arterial embolization and the reversal effect of the therapy was observed. Associations of HAVF with clinical and ultrasonographic features were evaluated by stepwise logistic regression analysis. RESULTS: Twenty-five of 78 HAVF patients were detected by ultrasonography and other imaging methods. Ultrasonographic parameters made excellent predictions for the patients with HAVF; sensitivity (SE) 83.3%, specificity (SP) 90.7%, positive predictive value (pPV, 80.0%), negative predictive value (nPV) 92.5% and accuracy 88.5%. Among the 25 HAVF patients, 16 were central hepatic artery-portal vein fistulae, seven were peri-hepatic artery-portal vein fistulae and two were hepatic artery-vein shunts. Characteristic ultrasonographic methods of hepatic artery-portal vein fistulae were as follows: 10 patients with hepatic artery-portal vein fistula were followed up after embolization. Compared with that of preembolization, seven cases returned to normal and in three patients abnormalities were still detected. CONCLUSION: Ultrasonographic evaluation of HAVF is easy to perform, reproducible and, when present, gives a high degree of certainty for the diagnosis of HAVF. Ultrasonography is a valuable method for the diagnoses HAVF; it can offer imaging evidence after the treatment of hepatic cell cancer. HAVF in patients with HCC can be detected by ultrasonographic methods, which are characterized by changes of hepatic arteries and veins involved in fistulas. These can be used for diagnosing HAVF and evaluating its arterial embolization effect in patients with HCC.     

人肝癌肿瘤相关抗原HCC-22-5抗体的制备及其在肝硬化组织中表达的临床意义

目的制备抗HCC02205的多克隆抗体,探讨其与肝硬化发生、发展的关系。方法将本课题组重组构建的含HCC-22-5cDNA序列表达质粒,经表达和纯化获得HCC-22-5的融合蛋白（MBP—HCC-22-5）,免疫家兔制备出抗MBP-HCC-22-5多克隆抗体。经ELISA和Westernblot鉴定抗体的免疫活性后,用免疫组化SABC法检测49例人肝硬化组织和30例正常人肝组织中HCC-22-5的表达。结果经ELISA和Westernblot鉴定所制备的多克隆抗体可以与MBP-HCC-22-5特异性结合。HCC-22-5主要表达于肝细胞质中。HCC-22．5在肝硬化组织中的表达与性别有关,且与年龄呈正相关。结论成功制备了抗HCC-22-5的多克隆抗体;HCC-22-5的表达与肝硬化的发生、发展有关。     

Value of three-dimensional reconstructions in pancreatic carcinoma using multidetector CT： Initial results

AIM: To evaluate the use of three-dimensional imaging of pancreatic carcinoma using multidetector computed tomography (CT) in a prospective study. METHODS: Ten patients with suspected pancreatic tumors were examined prospectively using multidetector CT (Somatom Sensation 16, Siemens, Erlangen, Germany). The images were evaluated for the presence of a pancreatic carcinoma and invasion of the peripancreatic vessels and surrounding organs. Using the isotropic CT data sets, a three-dimensional image was created with automatic vascular analysis and semiautomatic segmentation of the organs and pancreatic tumor by a radiologist. The CT examinations and the three-dimensional images were presented to the surgeon directly before and during the patient's operation using the Medical Imaging Interaction Toolkit-based software "ReLiver". Immediately after surgery, the value of the two images was judged by the surgeon. The operation and the histological results served as the gold standard. RESULTS: Nine patients had a pancreatic carcinoma (all pT3), and one patient had a serous cystadenoma. One tumor infiltrated the superior mesenteric vein. The infiltration was correctly evaluated. All carcinomas were resectable. In comparison to the CT image with axial and coronal reconstructions, the three-dimensional image was judged by the surgeons as better for operation planning and consistently described as useful. CONCLUSION: A 3D-image of the pancreas represents an invaluable aid to the surgeon. However, the 3D-software must be further developed in order to be integrated into daily clinical routine.     

Pulmonary infarction: spectrum of findings on multidetector helical CT

OBJECTIVE: Despite the dual blood supply to the lung, acute pulmonary embolism (PE) can lead to a spectrum of ischemic injury to the lung resulting in infarction and hemorrhage. In this series we systematically describe the spectrum of CT findings and clinical correlates of pulmonary infarction in patients with PE. METHODS: We retrospectively identified 24 consecutive adults with pulmonary infarction on multidetector CT between July 2002 and March 2004. There were 13 women and 11 men, with a mean age of 59 years. The cases were identified by review of 74 consecutive CTs demonstrating PE. Each CT was evaluated by 2 of 3 reviewers in consensus for presence and characteristics of peripheral parenchymal opacities and extent of PE. Peripheral opacities were evaluated for degree of enhancement, internal air lucencies, and contour. The presence of adjacent vessels and linear strands were noted. At the end of interpreting each case, the reviewers determined whether or not an infarct was present based on the constellation of previously described imaging features. The extent of pulmonary vascular obstruction was graded using the CT clot burden scoring system. Each chart was reviewed for predisposing factors for PE and infarction, presenting clinical symptoms/signs, and co-existing pulmonary or cardiac conditions. RESULTS: Thirty-two percent (24/74) of patients with PE had pulmonary infarction. Thirty-three percent (8/24) of patients had more than 1 infarct. Seventy-three percent (27/37) of infarcts were in the lower lobes. The CT findings of pulmonary infarction included: focal decrease in parenchymal enhancement in 95% (35/37), broad pleural base in 65% (24/37), truncated apex in 57% (21/37), convex border in 46% (17/37), internal air lucencies in 32% (12/37), linear stranding from the apex toward the hilum in 24% (9/37), and a thickened vessel leading to the apex of the infarct in 14% (5/37). There was a trend toward a higher mean clot burden (12.3 vs. 10.5) between the patients with PE with and without infarction. Ninety-six percent (23/24) of patients with pulmonary infarction had predisposing factors for infarction, including PE involving more than 1 lobe (n = 21), malignancy (n = 5), and heart failure (n = 3). Pleuritic chest pain was significantly more frequent in patients with infarction (P = 0.0064). CONCLUSION: Pulmonary infarction occurred in nearly 1/3 of patients with PE in this series. The infarcts were peripheral parenchymal opacities characterized by a distinctive complex of findings on CT reflecting ischemic injury in the setting of a dual blood supply to the lung. Pleuritic chest pain was significantly associated with infarction.     

门-体静脉分流术对肝性脊髓病的影响

目的探讨门-体静脉分流术与肝性脊髓病的关系以及对其发病率的影响。方法对11例肝性脊髓病患者的病因进行回顾性分析,(4例为口腔分流术后,3例为断流+分流,1例为脾切除后,余3例为自发性)。结果门-体分流术引起肝性脊髓病8例,占72.73％;明显高于自发性4例,占27.27％(P<0.01)。结论门-体分流术可增加肝性脊髓病的发病率。国外采用结肠脱离术治疗本病,对有肝衰竭患者可行肝移植术。     

原发性肝癌介入治疗后血流动力学变化的多层螺旋CT灌注成像

原发性肝癌发病率呈上升趋势,由于起病隐匿,70%～85%患者就诊时已属中晚期,失去外科手术治疗的机会,肝动脉灌注化疗栓塞术(TACE)通过阻断肝癌血供,导致肿瘤缺血,坏死,控制肿瘤进展、延长患者生存期,为其首选的治疗方法[1-2].     

Role of curved planar reformations using multidetector spiral CT in diagnosis of pancreatic and peripancreatic diseases

AIM: To investigate the role of curved planar reformations using multidetector spiral CT (MSCT) in diagnosis of pancreatic and peripancreatic diseases. METHODS: From October 2001 to September 2003, 47 consecutive patients with pancreatic or peripancreatic diseases, which were confirmed by operation, endoscopic retrograde cholangiopancreatography and clinical follow-up, were enrolled in this study. CT scanning was performed at a MSCT with four rows of detector. A set of images with an effective thickness of 1.0-2.0 mm and a gap of 0.5-1.0 mm (50% overlap) were acquired in all patients for post-processing. Curved planar reformations were carried out by drawing a curved line on transverse source images, coronal or sagittal multiplanar reformations according to certain anatomic structures (such as cholangiopancreatic ducts or peripancreatic vessels) and the position of lesion. RESULTS: With thin collimation, MSCT could acquire high-quality curved planar reformations to display the profile of the whole pancreas, to trace the cholangiopancreatic ducts and peripancreatic vessels, and to show the relationship of lesions with pancreas and peripancreatic anatomic structures in one curved plane, which facilitates diagnosis and rapid communication of diagnostic information with referring physicians. CONCLUSION: MSCT with thin collimation could be used to create high-quality curved planar reformations in evaluating pancreatic and peripancreatic diseases with pertinent anatomic information and relative pathologic signs to facilitate the diagnosis and enhance communication with the referring physician. Curved planar reformations can serve as supplements for transverse images in diagnosis and management of pancreatic and peripancreatic diseases.     

Budd-Chiari Syndrome: Long term success via hepatic decompression using transjugular intrahepatic porto-systemic shunt

Background  

Budd-Chiari syndrome (BCS) generally implies thrombosis of the hepatic veins and/or the intrahepatic or suprahepatic inferior vena cava. Treatment depends on the underlying cause, the anatomic location, the extent of the thrombotic process and the functional capacity of the liver. It can be divided into medical treatment including anticoagulation and thrombolysis, radiological procedures such as angioplasty and transjugular intrahepatic porto-systemic shunt (TIPS) and surgical interventions including orthotopic liver transplantation (OLT). Controlled trials or reports on larger cohorts are limited due to rare disease frequency. The aim of this study was to report our single centre long term results of patients with BCS receiving one of three treatment options i.e. medication only, TIPS or OLT on an individually based decision of our local expert group.     

Adjustment of lipiodol dose according to tumor blood supply during transcatheter arterial chemoembolization for large hepatocellular carcinoma by multidetector helical CT

AIM: To work out an individualized lipiodol dose in transcatheter arterial chemoembolization (TACE) for large hepatocellular carcinoma (HCC) according to its blood supply evaluated by CT. METHODS: One hundred patients with large HCC (more than 8 cm in diameter) were studied by multidetector helical CT. Patterns of blood supply of HCC were divided into sufficient blood supply, poor blood supply, mixed blood supply and arteriovenous (A-V) shunt. The dose of ultra-fluid lipiodol was determined by diameter and blood supply type of HCC. Patients were divided into two groups (50 cases each): lipiodol perfusion group and iodized oil perfusion group according to tumor diameter and the blood supply type of tumor. RESULTS: The confirmation and effective rates were 82%, 84% in the first group and 36%, 46% in the second group (P<0.01). CONCLUSION: A relatively individualized lipiodol dose may be determined according to the blood supply pattern and the tumor diameter by CT imaging.