Radionuclide angiography in two cases of hepatic actinomycosis

Primary hepatic actinomycosis is rare, and there have been few reports concerning its nuclear imaging findings. Two cases of actinomycosis, in which hypervascular hepatic masses were observed in the arterial phase of radionuclide angiography are reported. To the authors' knowledge, this finding has not been reported in the literature. In one of the two cases, intense Ga-67 uptake also was noted. Although the preoperative diagnosis based on the findings of nuclear imaging (liver scan, liver flow study, Ga-67 scan), ultrasound, CT, and angiography was hepatoma, hepatic masses in our cases proved to be hepatic actinomycosis. Because hepatic actinomycosis is rare, this disease is neglected often in the differential diagnosis of hepatic mass lesions. It should be included in the gamut of hypervascular hepatic mass lesions.     

超声引导下治疗非寄生虫性肝囊肿141例疗效分析

目的：分析超声引导下无水酒精治疗非寄生虫性肝囊肿141例的疗效。方法：采用超声引导下肝穿刺抽囊液后,反复注入无水酒精治疗非寄生虫性肝囊肿141例,其中单发77例,多发64例,肝左叶36例,右叶105例,肝囊肿最大径24cm,一次抽液量最多2200ml。结果：治疗效果与囊径大小有明显的关系,直径小于10cm,疗效较好,大于10cm者疗效较差。结论：非寄生虫性肝囊肿有症状的患者或囊径大于6cm者应积极治疗。     

Biochemical and cytologic analysis of cystic contents in benign non-parasitic symptomatic hepatic cysts before and after ethanol sclerotherapy

Purpose: To examine the fluid of liver cysts by cytologic and biochemical analysis before and after ethanol sclerotherapy in order to explore the etiology of cystic fluid reproduction after sclerotherapy.

Material and Methods: The contents of 11 cysts in 11 patients were examined on the day of sclerotherapy, and 2-8 (mean 4.5) days later, and analysed for cytologic and biochemical parameters.

Results: Cytologic signs of acute or subacute inflammatory reaction were absent before and present in all cysts after sclerotherapy. Biochemical parameters reflecting the acute inflammatory reaction (CRP, orosomucoid and haptoglobine), changes in capillary permeability (protein, albumin), and the cystic epithelial function (bilirubin, alkaline phosphatase) were significantly elevated after sclerotherapy.

Conclusion: The post-sclerotherapy fluid production is probably due to an inflammatory reaction. This may explain the success of performing sclerotherapy in one single session.     

2种硬化剂在单纯性肝肾囊肿硬化治疗中的对比研究

目的:对超声引导下单纯性肝肾囊肿穿刺注射新型硬化剂和无水乙醇治疗的疗效进行对比研究。方法:对32例患者36个肝肾囊肿(18例肝囊肿,14例18个肾囊肿)经超声引导抽净囊液后,注入适量新型硬化剂1%聚桂醇注射液(国药准字H20080445),并留置囊内,观察治疗过程中发生的不良反应、患者耐受程度,6月跟踪统计有效率;并与我院采用传统无水乙醇硬化剂治疗的肝肾囊肿统计数据进行对比。结果:32例36个囊肿均一次穿刺成功,按1/10～1/4的比例注入新型硬化剂并保留囊内,患者耐受性良好,无刺激性疼痛和醉酒症状,治疗后1周内,9例患者诉侧腹轻微胀痛,间断低热2 d,未经特殊处理自行消失,无严重不良反应。6月复查33例全部消失,3个囊肿缩小2/3以上,有效率达100%,长期疗效仍在跟踪中。采用传统无水乙醇作为硬化剂注射治疗肝肾囊肿20例(12例肝囊肿,8例肾囊肿),抽净囊液后,按1/4～1/3比例注入无水乙醇,注射时均有短暂刺激性疼痛,18例出现面红、心跳加快、口干、恶心呕吐等醉酒症状。6月复查15例完全消失,5例缩小2/3以上。结论:新型硬化剂聚桂醇治疗肝。肾囊肿疗效与传统无水乙醇硬化治疗一致,但它留置体内,无刺激性剧痛,无醉酒症状,操作简单,不良反应少,患者耐受性好,优于无水乙醇,有望在肝肾囊肿的硬化治疗中成为无水乙醇的替代物。     

Radionuclide cisternography for the study of arachnoid cysts: A case report

Summary A patient with agenesis of the temporal lobe and an arachnoid cyst was studied by radionuclide cisternography. The value of cisternography in establishing communication between the cyst and the subarachnoid space is emphasized.     

Radionuclide liver spots: indicator of liver disease or a blood flow phenomenon.

Abnormal areas of increased uptake on liver scan have been controversial. While often said to be associated with superior vena caval obstruction, three distinctly different findings are possible: hot spot, warm spot, and no spot. All of these changes can be readily explained by distinct, separate anatomic venous collateral pathways. Four cases of superior vena caval obstruction with isotopic liver flow studies are presented. Anatomy of the venous collateral system is reviewed, and the potential significance of the liver "warm spot" is considered.     

Percutaneous treatment of symptomatic non-parasitic benign liver cysts: Single-session alcohol sclerotherapy versus prolonged catheter drainage with negative pressure

To evaluate whether prolonged catheter drainage with negative pressure yields better results than single-session alcohol sclerotherapy in the treatment of symptomatic non-parasitic benign liver cysts. Forty patients were randomly assigned to two groups in a 24-month prospective controlled trial. One group was treated with ultrasound-guided prolonged catheter drainage with negative pressure (20 patients with 24 cysts) and the other group with single-session alcohol sclerotherapy (20 patients with 23 cysts). Patient demographics, clinical characteristics, treatment outcome, and complications were analyzed. The median volumes and 95% CI (confidence interval) for the medians and interquartile ranges of all 47 cysts before treatment and on last follow-up were: 389 ml, 143–1,127 ml, 136–1,300 ml, and 0 ml, 0–10 ml, and 0–23 ml, respectively (P<0.0001). The average volume reduction was 92.4% (range, 74.9–100%), 94.2 % (range, 74.9–100%) in the drainage and 90.2% (range, 76.9–100%) in the sclerotherapy group. Twenty-seven cysts (57.4%) disappeared completely, 16 (66.7%) in the drainage and 11 (47.8%) in the sclerotherapy group. No differences in average volume reduction, final volume and disappearance of the cysts between the groups were noted. The hospital stay was 1 day for all patients. Percutaneous treatment is safe and effective for hepatic non-parasitic cysts. Prolonged catheter drainage with negative pressure and single-session alcohol sclerotherapy had similar results. An erratum to this article can be found at     

MR findings in thyroglossal duct cysts: report of two cases

Two patients with thyroglossal duct cysts have been studied with CT and MR. The typical CT feature of these cystic upper-neck lesions are depicted in literature, conversely MR findings are not well known. The homogeneous high intensity on T1-weighted images, higher than simple cyst or fluid, is the most typical feature of the thyroglossal cyst.     

伴有皮层下囊肿的巨脑性脑白质病二例

例1 男,8岁.2009年1月10日以步态不稳、不能独立行走就诊.家长诉患儿出生时正常,1岁后头围明显增大,现头围60 cm,余体格检查未见异常.颅脑MRI示双侧大脑半球弥漫脑白质水肿,伴双侧颞叶前部皮质下大小不等囊肿样改变.     

False-positive liver scan in a patient with hepatic amyloidosis: case report.

A case of secondary hepatic amyloidosis exhibiting a large liver and multiple defects on the radiocolloid scintigraph is presented. Biopsy and angiographic studies indicated that the areas of reduced colloid uptake represented heavy amyloid deposition, and the area of the left lobe with contrasting high activity most probably represented compensatory hypertrophy.     

Radionuclide evaluation of liver transplants

Orthotopic liver transplantation is now an established technique for treating patients with various forms of end stage liver disease. The number of centers performing the procedure is increasing and, as the number of transplant recipients in the population increases, many institutions performing nuclear medicine studies will be confronted with requests to evaluate these patients. While a variety of radionuclides are proving useful in this evaluation, the 99mTc iminodiacetic acid (IDA) compounds, particularly 99mTc diisopropyl IDA (DISIDA), will probably account for the majority of radionuclide evaluations of these patients because they are well suited to monitor both structural and functional changes of the graft. The primary application of radionuclide studies is focused in the postoperative period, when problems with the vascular and biliary anastomoses, rejection, infections, and bile leaks all produce alterations in radionuclide hepatobiliary studies. Abnormalities such as rejection and infection produce primarily functional, rather than structural changes and are not easily differentiated based upon the kinetics of 99mTc-DISIDA extraction and excretion by the liver, serial imaging and correlation with clinical data is necessary in such situations. Quantitative analyses of kinetic 99mTc IDA (DISIDA) studies and quantitative approaches with other compounds such as 99mTc galactosyl-neoglycoalbumin (NGA) may permit better assessments of relatively subtle changes in liver function in the posttransplant period.     

儿童闭塞性细支气管炎的核素肺灌注/通气显像研究

目的 了解闭塞性细支气管炎(BO)患儿的核素肺V/Q显像表现及该项检查在BO患儿临床诊断、病情评估、预后判断方面的价值.方法 前瞻性分析2005年2月至2011年4月在首都医科大学附属北京儿童医院呼吸感染中心确诊的30例BO患儿(男18例,女12例,年龄7个月～ 14岁)的核素肺V/Q显像资料,对不同病情和不同预后的BO患儿分别加以分析,比较其各自累及的肺段数.结果 30例BO患儿肺灌注显像异常25例(83.3％),肺通气显像异常27例(90.0％).异常肺V/Q匹配者13例(48.1％),不匹配者1例(3.7％),反向不匹配者13例(48.1％).3例轻度病情患儿中,1例肺V/Q显像正常,另2例仅1个肺段受累.10例中度病情患儿肺灌注显像异常平均累及3.7个肺段,肺通气显像异常平均累及5.6个肺段.17例严重病情患儿平均6.0个肺段肺灌注显像异常,平均8.2个肺段肺通气显像异常.30例患儿出院后随访到24例,其中8例病情加重患儿肺灌注显像异常累及肺段数量及受损程度明显高于16例复查好转患儿.结论 BO患儿的肺V/Q显像呈现肺段性、多发性肺灌注和(或)通气稀疏或缺损.该显像方法对BO患儿的临床诊断、病情评估及预后判断有重要意义.