To evaluate the respective value of dual- phase helical CT arterial portography (CTAP) and conventional angiography in preoperative predicting resectability of pancreatic ductal adenocarcinoma. Subjects and methods. T...To evaluate the respective value of dual- phase helical CT arterial portography (CTAP) and conventional angiography in preoperative predicting resectability of pancreatic ductal adenocarcinoma. Subjects and methods. Tumor resectability was prospectively evaluated in 54 patients with pathologically proven pancreatic ductal adenocarcinoma who later underwent surgery. Both dual- phase helical CT scanning and selective angiography were obtained in each patient preoperatively. For optimal enhancement of pancreas and major peripancreatic vessels, two catheters connected to an automatic injector via a Y- shaped tube were placed after selective angiography,one in celiac trunk, the other in superior mesenteric artery. Then the patient underwent dual- phase helical CTAP of pancreas and liver. The criteria of irresectability for CTAP include: tumor diameter≥ 5 cm,extrapancreatic invasion, distant metastases and vascular involvement(occlusion, stenosis or semicircular encasement of superior mesenteric artery, hepatic artery, splenic artery, celiac axis; portal vein, superior mesenteric vein or splenic vein). The results of both modalities were correlated with findings from surgery or pathology. Results. Thirty- eight of 54 patients had nonresectable disease. In prediction the irresectability, sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy were 94.7％ ,100％ ,100％ ,88.9％ ,96.3％ respectively for helical CTAP and 63.2％ ,93.8％ ,96.0％ ,51.7％ ,72.2％ respectively for selective angiography. In assessing vascular involvements, dual- phase helical CTAP was also superior to selective angiography. Conclusion. Dual- phase helical CTAP is superior to angiography in assessing resectability of pancreatic ductal adenocarcinoma. The combination of the two modalities may further improve overall accuracy of assessment.展开更多
AIM To recognize the characteristic findings of micrQliver cancer (MLC) and to evaluate the effect of CT arterial portography (CTAP) and CT hepatic arteriography (CTHA) in diagnosis of MLC. METHODS Between April 1996 ...AIM To recognize the characteristic findings of micrQliver cancer (MLC) and to evaluate the effect of CT arterial portography (CTAP) and CT hepatic arteriography (CTHA) in diagnosis of MLC. METHODS Between April 1996 to December 1998, CTAP and CTHA were performed in 12patients with MLC, which were not detect ed byconventional CT examinations. After CTHA, 3 mL-- 5 mL mixture of lipiodol, doxorubic in andmitomycin C were injected into hepatic arterythrough the catheter, and then followed up by CTthree or four weeks later (Lipiodol CT LP-CT).RESULTS A total of 22 micro--tumors (0 .2 cm 0.6 cm in diameter ) were detected in 12patients, which manifested as small perfusiondefects in CTAP and small round enhancement inCTHA. The rate of detectability of CTAP andCTHA was 68.2% (15/ 22) and 77.3% (17/ 22)respectively, and the rate of the simultaneoususe of both procedures reached 86. 4% (19/ 22 ).All micro--tumors were demonstrated as punctatelipiodol deposit fool in LP--CT. After LP--CT, theelevated serum level of Q-fetoprotein (AFP)dropped to the normal level in all patients.CONCLUSION The CTAP and CTHA are the mostsensitive imaging methods for detecting microIiver cancer. Confirmed by the change of theelevated serum AFP level and lipiodol depositfool in LP-CT, small perfusion defects in CTAPand punctate enhancement in CTHA may suggestmicro--liver cancer.展开更多
We present a rare case of well-to moderately-differentiated hepatocellular carcinoma (HCC) in a 71-year-old woman with hepatitis C virus-related cirrhosis and unusual radiologic features. A 20-mm hypoechoic nodule dis...We present a rare case of well-to moderately-differentiated hepatocellular carcinoma (HCC) in a 71-year-old woman with hepatitis C virus-related cirrhosis and unusual radiologic features. A 20-mm hypoechoic nodule disclosed by ultrasound in segment two showed hyperattenuation on both computed tomography hepatic arteriography and computed tomography during arterial portography. Contrast-enhanced ultrasound revealed hypervascularity in the early vascular phase and defect in the post-vascular phase, with the same pattern detected by the two imaging techniques. SPIO-MRI revealed a hyperintense nodule. These findings were compatible with those of moderately-differentiated HCC. An ultrasound-guided biopsy showed histological features of well-to moderately-differentiated HCC characterized by more than two-fold the cellularity of the non-tumorous area, fatty change, clear cell change and mild cell atypia with a thin to mid-trabecular pattern. Further studies may provide insights into the correlation between tumor neovascularity in multistep hepatocarcinogenesis and dual hemodynamics, including the artery and the portal vein.展开更多
Objective: To evaluate the enhancement characteristics of the hepatic parenchyma during scanning with computed tomography (CT) during splenoportography (CTSP). Methods: Thirty patients refferred for CTSP were included...Objective: To evaluate the enhancement characteristics of the hepatic parenchyma during scanning with computed tomography (CT) during splenoportography (CTSP). Methods: Thirty patients refferred for CTSP were included in the study. Attenuation was measured at different time after contrast medium injection, and time-attenuation curves were created. Enhancement characteristics were evaluated, and the parenchyma-to-tumor difference of attenuation were compared. Results: CTSP led to high parenchymal enhancement. The highest enhancement value in the left lobe was (218. 0±53. 2) Hu and (246. 0±60. 2) Hu in the right lobe. The difference between the right and left lobes was statistically significant (P<0. 05); The parenchyma-to-tumor difference of (65. 3±25. 6) Hu was observed during scanning after injection. Conclusion: The high levels of liver parenchymal enhancement and parenchyma-to-lesion contrast can be achieved within the scanning time with CTSP.展开更多
Objective To introduce computed tomography via percutaneous splenoportography (CTSP), a new method for determining hepatic diseases Methods Ten hybrid dogs and 31 patients with primary hepatic cancer (PHC) were in...Objective To introduce computed tomography via percutaneous splenoportography (CTSP), a new method for determining hepatic diseases Methods Ten hybrid dogs and 31 patients with primary hepatic cancer (PHC) were included in the study Each dog was examined by CT, computed tomography via arterial portography (CTAP), and CTSP to compare the enhanced density of the liver The 31 patients were examined by CTSP and the appearanec of PHC was compared with their pathological results to evaluate the diagnostic significance of CTSP Results The animal experiment showed that both CTAP and CTSP could obviously enhance the density of the liver ( P <0 01), but no significant difference was observed in the enhanced densities between the two methods ( P >0 05) On the CTSP images of the 31 patients, the density of the livers was increased to 168-192?Hu, whereas the density of the cancers was as low as that on the images of CT scans (<58?Hu) The CTSP findings were consistent with the surgical ones from space occupying lesions The diagnostic value of CTSP was obviously superior to that of general enhanced CT However, it was difficult for CTSP to show nodules less than 1?cm in size located on the surface of the liver or the hepatic portal zone Conclusions Like CTAP, CTSP is also a sensitive method for showing occupant in the liver But the equipments and the procedures are simpler for CTSP than for CTAP CTSP is an alternative procedure in clinical practice展开更多
We describe a 15-mm scirrhous hepatocellular carcinoma （HCC） in a 60-year-old man with B-type cirrhosis. Ultrasound disclosed a 15-mm hypoechoic nodule in segment 7. Contrast-enhanced US revealed heterogeneous, not ...We describe a 15-mm scirrhous hepatocellular carcinoma （HCC） in a 60-year-old man with B-type cirrhosis. Ultrasound disclosed a 15-mm hypoechoic nodule in segment 7. Contrast-enhanced US revealed heterogeneous, not diffuse, hypervascularity in the early phase and a defect in the Kupffer phase.Contrast-enhanced computed tomography （CT） revealed a heterogeneous hypervascular nodule in the early phase and a low-density area in the late phase.Magnetic resonance imaging （MRI） revealed iso- to hypointensity at T1 and high intensity at T2-weighted sequences. Contrast-enhanced MRI also revealed a heterogeneous hypervascular nodule in the early phase and washout in the late phase. Super-paramagnetic iron oxide-MRI revealed a hvoerintense nodule. CT during hepatic arteriography and CT during arterial portography revealed heterogeneous hyperattenuation and a perfusion defect, respectively. Based on these imaging findings the nodule was diagnosed as a mixed well-differentiated and moderately-differentiated HCC.Histologically, the nodule was moderately-differentiated HCC characterized by typical cytological and structural atypia with dense fibrosis. Immunohistochemically,the nodule was positive for heterochromatin protein 1 and alpha-smooth muscle actin, and negative for cytokeratin 19. From the above findings, the nodule was diagnosed as scirrhous HCC. Clinicians engaged in hepatology should exercise caution with suspected scirrhous HCC when imaging studies reveal atypical findings, as shown in our case on the basis of chronic liver disease.展开更多
文摘To evaluate the respective value of dual- phase helical CT arterial portography (CTAP) and conventional angiography in preoperative predicting resectability of pancreatic ductal adenocarcinoma. Subjects and methods. Tumor resectability was prospectively evaluated in 54 patients with pathologically proven pancreatic ductal adenocarcinoma who later underwent surgery. Both dual- phase helical CT scanning and selective angiography were obtained in each patient preoperatively. For optimal enhancement of pancreas and major peripancreatic vessels, two catheters connected to an automatic injector via a Y- shaped tube were placed after selective angiography,one in celiac trunk, the other in superior mesenteric artery. Then the patient underwent dual- phase helical CTAP of pancreas and liver. The criteria of irresectability for CTAP include: tumor diameter≥ 5 cm,extrapancreatic invasion, distant metastases and vascular involvement(occlusion, stenosis or semicircular encasement of superior mesenteric artery, hepatic artery, splenic artery, celiac axis; portal vein, superior mesenteric vein or splenic vein). The results of both modalities were correlated with findings from surgery or pathology. Results. Thirty- eight of 54 patients had nonresectable disease. In prediction the irresectability, sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy were 94.7％ ,100％ ,100％ ,88.9％ ,96.3％ respectively for helical CTAP and 63.2％ ,93.8％ ,96.0％ ,51.7％ ,72.2％ respectively for selective angiography. In assessing vascular involvements, dual- phase helical CTAP was also superior to selective angiography. Conclusion. Dual- phase helical CTAP is superior to angiography in assessing resectability of pancreatic ductal adenocarcinoma. The combination of the two modalities may further improve overall accuracy of assessment.
基金Supported by“9.5”National Major Project of National Cammittee of Sciences and Technology,No.96-907-03-02.
文摘AIM To recognize the characteristic findings of micrQliver cancer (MLC) and to evaluate the effect of CT arterial portography (CTAP) and CT hepatic arteriography (CTHA) in diagnosis of MLC. METHODS Between April 1996 to December 1998, CTAP and CTHA were performed in 12patients with MLC, which were not detect ed byconventional CT examinations. After CTHA, 3 mL-- 5 mL mixture of lipiodol, doxorubic in andmitomycin C were injected into hepatic arterythrough the catheter, and then followed up by CTthree or four weeks later (Lipiodol CT LP-CT).RESULTS A total of 22 micro--tumors (0 .2 cm 0.6 cm in diameter ) were detected in 12patients, which manifested as small perfusiondefects in CTAP and small round enhancement inCTHA. The rate of detectability of CTAP andCTHA was 68.2% (15/ 22) and 77.3% (17/ 22)respectively, and the rate of the simultaneoususe of both procedures reached 86. 4% (19/ 22 ).All micro--tumors were demonstrated as punctatelipiodol deposit fool in LP--CT. After LP--CT, theelevated serum level of Q-fetoprotein (AFP)dropped to the normal level in all patients.CONCLUSION The CTAP and CTHA are the mostsensitive imaging methods for detecting microIiver cancer. Confirmed by the change of theelevated serum AFP level and lipiodol depositfool in LP-CT, small perfusion defects in CTAPand punctate enhancement in CTHA may suggestmicro--liver cancer.
文摘We present a rare case of well-to moderately-differentiated hepatocellular carcinoma (HCC) in a 71-year-old woman with hepatitis C virus-related cirrhosis and unusual radiologic features. A 20-mm hypoechoic nodule disclosed by ultrasound in segment two showed hyperattenuation on both computed tomography hepatic arteriography and computed tomography during arterial portography. Contrast-enhanced ultrasound revealed hypervascularity in the early vascular phase and defect in the post-vascular phase, with the same pattern detected by the two imaging techniques. SPIO-MRI revealed a hyperintense nodule. These findings were compatible with those of moderately-differentiated HCC. An ultrasound-guided biopsy showed histological features of well-to moderately-differentiated HCC characterized by more than two-fold the cellularity of the non-tumorous area, fatty change, clear cell change and mild cell atypia with a thin to mid-trabecular pattern. Further studies may provide insights into the correlation between tumor neovascularity in multistep hepatocarcinogenesis and dual hemodynamics, including the artery and the portal vein.
文摘Objective: To evaluate the enhancement characteristics of the hepatic parenchyma during scanning with computed tomography (CT) during splenoportography (CTSP). Methods: Thirty patients refferred for CTSP were included in the study. Attenuation was measured at different time after contrast medium injection, and time-attenuation curves were created. Enhancement characteristics were evaluated, and the parenchyma-to-tumor difference of attenuation were compared. Results: CTSP led to high parenchymal enhancement. The highest enhancement value in the left lobe was (218. 0±53. 2) Hu and (246. 0±60. 2) Hu in the right lobe. The difference between the right and left lobes was statistically significant (P<0. 05); The parenchyma-to-tumor difference of (65. 3±25. 6) Hu was observed during scanning after injection. Conclusion: The high levels of liver parenchymal enhancement and parenchyma-to-lesion contrast can be achieved within the scanning time with CTSP.
文摘Objective To introduce computed tomography via percutaneous splenoportography (CTSP), a new method for determining hepatic diseases Methods Ten hybrid dogs and 31 patients with primary hepatic cancer (PHC) were included in the study Each dog was examined by CT, computed tomography via arterial portography (CTAP), and CTSP to compare the enhanced density of the liver The 31 patients were examined by CTSP and the appearanec of PHC was compared with their pathological results to evaluate the diagnostic significance of CTSP Results The animal experiment showed that both CTAP and CTSP could obviously enhance the density of the liver ( P <0 01), but no significant difference was observed in the enhanced densities between the two methods ( P >0 05) On the CTSP images of the 31 patients, the density of the livers was increased to 168-192?Hu, whereas the density of the cancers was as low as that on the images of CT scans (<58?Hu) The CTSP findings were consistent with the surgical ones from space occupying lesions The diagnostic value of CTSP was obviously superior to that of general enhanced CT However, it was difficult for CTSP to show nodules less than 1?cm in size located on the surface of the liver or the hepatic portal zone Conclusions Like CTAP, CTSP is also a sensitive method for showing occupant in the liver But the equipments and the procedures are simpler for CTSP than for CTAP CTSP is an alternative procedure in clinical practice
文摘We describe a 15-mm scirrhous hepatocellular carcinoma （HCC） in a 60-year-old man with B-type cirrhosis. Ultrasound disclosed a 15-mm hypoechoic nodule in segment 7. Contrast-enhanced US revealed heterogeneous, not diffuse, hypervascularity in the early phase and a defect in the Kupffer phase.Contrast-enhanced computed tomography （CT） revealed a heterogeneous hypervascular nodule in the early phase and a low-density area in the late phase.Magnetic resonance imaging （MRI） revealed iso- to hypointensity at T1 and high intensity at T2-weighted sequences. Contrast-enhanced MRI also revealed a heterogeneous hypervascular nodule in the early phase and washout in the late phase. Super-paramagnetic iron oxide-MRI revealed a hvoerintense nodule. CT during hepatic arteriography and CT during arterial portography revealed heterogeneous hyperattenuation and a perfusion defect, respectively. Based on these imaging findings the nodule was diagnosed as a mixed well-differentiated and moderately-differentiated HCC.Histologically, the nodule was moderately-differentiated HCC characterized by typical cytological and structural atypia with dense fibrosis. Immunohistochemically,the nodule was positive for heterochromatin protein 1 and alpha-smooth muscle actin, and negative for cytokeratin 19. From the above findings, the nodule was diagnosed as scirrhous HCC. Clinicians engaged in hepatology should exercise caution with suspected scirrhous HCC when imaging studies reveal atypical findings, as shown in our case on the basis of chronic liver disease.
