Does providing routine liver volume assessment add value when performing CT surveillance in cirrhotic patients?

Background

The measurement of liver volume (LV) is considered to be an effective prognosticator for postoperative liver failure in patients undergoing hepatectomy. It is unclear whether LV can be used to predict mortality in cirrhotic patients.

Methods

We enrolled 584 consecutive cirrhotic patients who underwent computerized topography (CT) of the abdomen for hepatocellular carcinoma surveillance and 50 age, gender, race, and BMI-matched controls without liver disease. Total LV (TLV), functional LV (FLV), and segmental liver volume (in cm³) were measured from CT imaging. Cirrhotic subjects were followed until death, liver transplantation, or study closure date of July 31, 2016. The survival data were assessed with log-rank statistics and independent predictors of survival were performed using Cox hazards model.

Results

Cirrhotic subjects had significantly lower TLV, FLV, and segmental (all except for segments 1, 6, 7) volume when compared to controls. Subjects presenting with hepatic encephalopathy had significantly lower TLV and FLV than those without HE (p = 0.002). During the median follow-up of 1145 days, 112 (19%) subjects were transplanted and 131 (23%) died. TLV and FLV for those who survived were significantly higher than those who were transplanted or dead (TLV:1740 vs. 1529 vs. 1486, FLV 1691 vs. 1487 vs. 1444, p < 0.0001). In the Cox regression model, age, MELD score, TLV, or FLV were independent predictors of mortality.

Conclusion

Baseline liver volume is an independent predictor of mortality in subjects with cirrhosis. Therefore, it may be useful to provide these data while performing routine surveillance CT scan as an important added value. Further studies are needed to validate these findings and to better understand their clinical utility.

     

Cystic neoplasms of the pancreas; findings on magnetic resonance imaging with pathological,surgical, and clinical correlation

Pancreatic cysts are increasingly being identified by cross-sectional imaging studies. Pancreatic cystic lesions comprise a spectrum of underlying pathologies ranging from benign and pre-malignant lesions to frank malignancies. Magnetic resonance imaging with cholangiopancreatography is a non-invasive imaging modality used for the characterization of cystic pancreatic lesions. This article will review the most common pancreatic cystic neoplasms and the utility of MR imaging in the characterization of these cysts.     

Sub-clinical systemic lupus erythematosus presenting with acute myocarditis.

A 46 year old woman presented with fever and normochromic anaemia followed rapidly by severe myocardial failure, unresponsive to maximum inotropic support and broad spectrum antibiotics. There were no classical clinical stigmata of systemic lupus erythematosus (SLE) but a possible immunological cause was looked for, and on the basis of her immuno-serology a diagnosis of SLE-like disease was made. She responded rapidly to high dose steroids. The importance of considering the possibility of SLE or ''lupus overlap'' in an acutely ill ''undiagnosed'' patient is emphasized. The relevance of instigating appropriate immuno-serological tests in the course of such an illness is discussed.     

Routine isotropic computed tomography scanning of the abdomen and pelvis

For 30 years, abdominal CT has been imaged and reviewed in the axial plane. It is now possible to carry out isotropic imaging of the whole abdomen and pelvis using a 40-channel scanner. This allows creation of coronal and sagittal reformats with the same image quality as the axial images. In this study, we present our experience of reviewing routinely coronal and, occasionally, sagittal reformats. We discuss situations where these nonaxial reformats are most beneficial.     

Fetal magnetic resonance imaging

PURPOSE OF REVIEW: Fetal magnetic resonance imaging is becoming more used in the evaluation of complex fetal abnormalities. Rapid advances in the technology and application of fetal magnetic resonance imaging necessitate a review of this subject. RECENT FINDINGS: Diffusion-weighted imaging, magnetic resonance spectroscopy and functional magnetic resonance imaging may allow assessment of fetal brain even before anatomical abnormalities are demonstrated. We discuss the uses of fetal magnetic resonance imaging in better assessment of pulmonary hypoplasia, congenital diaphragmatic hernia and renal anomalies. SUMMARY: The additional information from fetal magnetic resonance imaging, beyond that obtained by ultrasound, is invaluable in prenatal counseling, delivery planning and planning for pre- or postnatal intervention. As intrauterine and neonatal surgery evolve, so will the utilization of fetal magnetic resonance imaging.     

Enteric drainage pancreatic transplantation

Enteric drainage is currently the preferred method of pancreatic transplantation. This technique results in long-term good control of diabetes. In this report we discuss the postoperative radiologic anatomy and complications.     

Evaluation of response after stereotactic body radiotherapy for hepatocellular carcinoma

BACKGROUND:

Hepatocellular carcinoma (HCC) is increasing in incidence due to hepatitis C. Stereotactic body radiotherapy (SBRT) is a noninvasive, effective therapy in the management of liver malignancies. The authors evaluated radiological response in 26 patients with HCC treated with SBRT at Indiana University.

METHODS:

Between March 2005 and June 2008, 26 patients with HCC who were not surgical candidates were enrolled in a phase 1 to 2 trial. Eligibility criteria included solitary tumors ≤ 6 cm or up to 3 lesions with sum diameters ≤ 6 cm, and well‐compensated cirrhosis. All patients had imaging before, at 1 to 3 months, and every 3 to 6 months after SBRT.

RESULTS:

Patients received 3 to 5 fractions of SBRT. Median SBRT dose was 42 Gray (Gy) (range: 24‐48 Gy). Median follow‐up was 13 months. Per Response Evaluation Criteria in Solid Tumors (RECIST), 4 patients had a complete response (CR), 15 had a partial response (PR), and 7 achieved stable disease (SD) at 12 months. One patient with SD experienced progression marginal to the treated area. The overall best response rate (CR + PR) was 73%. In comparison, by European Association for the Study of the Liver (EASL) criteria, 18 of 26 patients had ≥ 50% nonenhancement at 12 months. Thirteen of 18 demonstrated 100% nonenhancement, being > 50% in 5 patients. Kaplan‐Meier 1‐ and 2‐year survival estimates were 77% and 60%, respectively.

CONCLUSIONS:

SBRT is effective therapy for patients with HCC with an overall best response rate (CR + PR) of 73%. Nonenhancement on imaging, a surrogate for ablation, may be a more useful indicator than size reduction in evaluating HCC response to SBRT in the first 6 to 12 months, supporting EASL criteria. Cancer 2012;118: 3191–98. © 2011 American Cancer Society.     

Distinguishing gelatin bioabsorbable sponge and postoperative abdominal abscess on CT

OBJECTIVE: The objective of our study was to differentiate the CT findings of gelatin bioabsorbable sponges used as hemostatic agents from postoperative abdominal abscess. CONCLUSION: Gelatin absorbable sponge may mimic a postoperative abscess on CT. Findings that may help differentiate the hemostatic agent from abscess include linear arrangement of tightly packed gas bubbles, fixed position of gas bubbles on subsequent examinations, shape, lack of air-fluid level, and lack of enhancing wall.     

Routine isotropic computed tomography scanning of the abdomen and pelvis

For 30 years, abdominal CT has been imaged and reviewed in the axial plane. It is now possible to carry out isotropic imaging of the whole abdomen and pelvis using a 40‐channel scanner. This allows creation of coronal and sagittal reformats with the same image quality as the axial images. In this study, we present our experience of reviewing routinely coronal and, occasionally, sagittal reformats. We discuss situations where these nonaxial reformats are most beneficial.