Abdominal Imaging

We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) treatments of hepatocellular carcinoma (HCC). One-hundred forty-eight HCCs were studied using CEUS: 110 nodules were treated with RFA [41/110 RFA were performed using a pretreatment and an immediate postablation evaluation using CEUS (group 1); 69/110 using only US guidance (group 2)] and 38 nodules treated with TACE. For statistical analysis, McNemar test was used. Overall complete response was observed in 107/148 nodules (92/110 treated with RFA and 15/38 with TACE). A better rate of complete response was found in group 1 compared to group 2 (92.7% vs. 78.3%). In RFA treatment, CEUS showed a sensitivity of 83.3% and a specificity of 100% (diagnostic accuracy of 97%) using MDCT as reference standard with no statistical difference (p > 0.05). CEUS detected all cases of incomplete response in HCC treated with TACE using angiography as reference standard (diagnostic accuracy 100%). We recommend assessing residual intratumoral flow on CEUS during RFA procedure to determine the necessity of immediate additional treatment. In case of positive CEUS results, HCC treated with TACE should be considered still viable.

Background: To evaluate the utility of dual-phase spiral computed tomography during gastric arteriography (CTGA) in the preoperative staging of gastric cancers. Methods: We performed CTGA in 21 patients with pathologically proven gastric cancers. CTGA findings were prospectively analyzed and correlated with surgical and pathologic findings. Dual-phase scans were performed at 10 s (early) and 60–100 s (delayed) after injection of 120 mL of contrast medium at an injection rate of 6 mL/s through a preset 5-Fr catheter positioned in the celiac trunk. Spiral CT scans were assessed for enhancing pattern of the normal gastric wall, tumor detectability, and accuracy of tumor staging. Results: Normal gastric mucosa was clearly visible as two or three layers in all patients on early-phase scans and in eight patients on delayed-phase scans. The primary tumors were correctly detected with CTGA in seven (88%) of the eight early gastric cancers and in all 13 (100%) advanced gastric cancers. The accuracy of CTGA for T staging was 50% and 77% in early and advanced gastric cancers, respectively. The overall accuracy for tumor detection and T staging was 95% and 67%, respectively. The accuracy of CTGA for the degree of serosal invasion and regional lymph node metastasis was 77% and 76%, respectively. Conclusion: The CTGA technique improved tumor detection rate and accuracy of tumor staging, especially in early gastric cancer, and may be very useful in the preoperative staging of gastric cancer.

A study of causes of error on barium enema examinations is reported. There were 144 patients with 189 inflammatory and neoplastic lesions of the large bowel examined endoscopically and with a preceding barium enema. Twelve lesions were not reported radiologically, a false negative error rate of 6.3%. Radiographic errors included 11 polyps and 1 sigmoid carcinoma. Causes for these errors were analyzed and classified into perceptive, technical, or combined categories. Ten lesions were visible in retrospect. Five lesions, clearly visible but not noted, were due to perceptive error. Five other lesions, poorly visible due to faulty studies, represented combined error. Two lesions could not be identified and represented purely technical failure. All unreported lesions were distal to the splenic flexure with the majority located in the sigmoid colon.

Direct communication between portal branches and the hepatic vein [macroscopic intrahepatic portal-hepatic venous shunt (IPHVS)] is a rare entity. We have recently studied five patients with this condition. Magnetic resonance imaging (MRI) clearly demonstrated in each case the portal-hepatic venous shunt due to “flow void. “ Multiple diffuse shunts were present in one case and a solitary shunt was demonstrated in the others. The solitary shunt was either tubular, focally dilated or racemose in configuration. The MRI findings and clinical significance of this rare entity are discussed.

Background: Active lower gastrointestinal (GI) bleeding is a potentially dangerous situation because patients with this condition may fall into shock. Colonoscopy, angiography, and scintigraphy have been used widely to localize the source of bleeding, but time is needed to perform these examinations. The purpose of this study was to illustrate how vividly enhanced computed tomography (CT) may show active lower GI bleeding in a short time. Methods: Five of 10 patients with active lower GI bleeding underwent dynamic enhanced CT. Scans were obtained 0.5 and 5 min after intravenous contrast. Results: Pooling of contrast medium was found in four of five patients. Among the five patients, three had diverticular disease of the colon, one had a rectal ulcer, and one had a small intestinal ulcer. The localization procedure completed within 15 min in all patients. Extravasations of medium were confirmed by two surgeons. Conclusion: Enhanced helical CT was useful for the detection of an active lower GI bleeding source. The procedure was brief, less invasive, and less demanding. Enhanced CT may be the first step for diagnosing lower GI tract bleeding.

We retrospectively evaluated the value of the combination of ultrasonographic guidance for jugular vein puncture and an automated biopsy device for transjugular liver biopsy. Transjugular liver biopsy was performed with ultrasonographic guidance for right internal jugular vein puncture and an automated device for hepatic tissue sampling (Quick-Core®) in 200 consecutive patients in whom percutaneous transhepatic biopsy was contraindicated. Histopathologic specimens were reviewed for adequacy and complications related to the procedure were analyzed. Biopsies were technically successful in 198 of 200 (99%) patients. The two cases of technical failure were due to an acute angle between right hepatic vein and inferior vena cava (1%). Adequate gross hepatic tissue specimens (mean length, 11. 0 mm ± 5.3; range, 5.0–20.0 mm) were obtained in 198 (99%) patients, allowing definitive histological diagnosis in 196 of 198 patients, for an overall success rate of 98%. Neither cases of inadvertent injury of the carotid artery nor life-threatening intraperitoneal bleeding were observed. Minor complications were noted in 24/200 (12%) patients. The combination of ultrasonographic guidance for jugular vein puncture and an automated biopsy device for tissue sampling is recommended for transjugular liver biopsy as it results in a safe, well-tolerated, and efficient technique.

Awareness of and communication about issues related to radiation dose are beneficial for patients, clinicians, and radiology departments. Initiating and facilitating discussions of the net benefit of CT by enlisting comparisons to more familiar activities, or by conveying that the anticipated radiation dose to an exam is similar to or much less than annual background levels help resolve the concerns of many patients and providers. While radiation risk estimates at the low doses associated with CT contain considerable uncertainty, we choose to err on the side of safety by assuming a small risk exists, even though the risk at these dose levels may be zero. Thus, radiologists should individualize CT scans according to patient size and diagnostic task to ensure that maximum benefit and minimum risk is achieved. However, because the magnitude of net benefit is driven by the potential benefit of a positive exam, radiation dose should not be reduced if doing so may compromise making an accurate diagnosis. The benefits and risks of CT are also highly individualized, and require consideration of many factors by patients, clinicians, and radiologists. Radiologists can assist clinicians and patients with understanding many of these factors, including test performance, potential patient benefit, and estimates of potential risk.

Hai tuần sau liệu pháp tiêm ethanol xuyên qua da để điều trị ung thư biểu mô tế bào gan, với việc tiêm 110 mL ethanol trong một phiên duy nhất dưới gây mê toàn thân, một phụ nữ 69 tuổi mắc xơ gan bù bắp tốt đã phát triển thuyên tắc toàn bộ hệ thống tĩnh mạch cửa, dẫn đến tình trạng cổ trướng không thể điều chỉnh và tình trạng chung của bà ngày càng xấu đi, dẫn đến tử vong 6 tuần sau thủ thuật.