Akio Todo

Functional hepatic imaging with receptor-binding radiopharmaceutical: Clinical potential as a measure of functioning hepatocyte mass

SummaryAsialoglycoprotein receptor (ASGP-R) is a hepatic cell surface receptor specific for galactose-terminated glycoproteins. Technetium-99m diethylenetriaminepentaacetic acid-galactosyl human serum albumin (TcGSA) is a newly developed analog ligand to ASGP-R. Fourteen human subjects were studied: three normal volunteers, one with chronic hepatitis, 6 with liver cirrhosis, and 4 with hepatocellular carcinoma associated with liver cirrhosis. The receptor index parameter (LHL15), was obtained from the liver and heart time-activity data as the ratio of radioactivity of the liver over that of the liver plus heart at 15 min after intravenous injection of 1 mg of TcGSA. Means±standard deviations of LHL15 in normal volunteers (3 cases), patients with mild (4 cases), moderate (2 cases), and severe liver damage (5 cases) were 0.933±0.006, 0.789±0.045, 0.723±0.033, and 0.488±0.094, respectively. The difference between the mean values of each group was statistically significant (P<0.05). LHL15 correlated well with classical indicators for hepatic functional capacity such as serum albumin level, serum bilirubin level, prothrombin time, ICG R15 or Child-Turcotte criteria score. Our preliminary experiences of high correlations of TcGSA functional imaging data with clinical data suggest that the dynamic data using this receptor-binding radiopharmaceutical provides invaluable information with regard to liver function, and thus, the TcGSA study is potentially a noninvasive practical tool to measure functioning hepatocyte mass.

Detection of Helicobacter pylori Gene by Means of Immunomagnetic Separation-Based Polymerase Chain Reaction in Feces

BACKGROUND Detection of Helicobacter pylori is usually performed by culture, polymerase chain reaction (PCR), histology, or urease test on gastric biopsy samples. Although methods based on feces are non-invasive, their sensitivity has been relatively low. In this study, to improve its sensitivity, immunomagnetic separation (IMS) was used as a pre-PCR step for direct detection of H. pylori in feces. METHODS Fresh fecal samples were taken from 72 patients attending for endoscopy. Of these, 57 patients had a positive H. pylori status according to the results of culture, histology, and PCR on gastric biopsy samples. Anti-H. pylori antibody-sensitized immunomagnetic beads were used to concentrate the bacteria. PCR was then performed to detect the H. pylori urease A-encoding gene. RESULTS Of the 57 H. pylori-positive patients, 35 (61.4%) had positive fecal samples by IMS-based PCR method. None of the 15 H. pylori-negative patients had positive fecal samples. The sensitivity of this method was 61.4%, and the specificity 100.0%. CONCLUSIONS This study confirms that non-invasive diagnosis of H. pylori infection could be made from feces by using IMS-based PCR.

Hepatic angiomyolipoma pre-operatively diagnosed by imaging

An asymptomatic patient with pre‐operatively diagnosed solitary angiomyolipoma is reported. The tumour was a well defined, fat density mass on computerized tomography (CT) and magnetic resonance imaging (MRI), and a hyperechoic nodule with a sharp margin on ultrasonography (US). The lesion was hypervascular on arteriography and CT during hepatic angiography. Chemical shift MRI confirmed the fat component within the lesion. Although a review of the literature shows this tumour to be rare and difficult to differentiate from a malignant lesion pre‐operatively, the pre‐operative diagnosis of angiomyolipoma is considered feasible when the characteristic findings as described here are present.

Endoscopic retrograde extraction of common bile duct stones with drip infusion of isosorbide dinitrate

Patients with choledocholithiasis, especially following cholecystectomy or in poor risk groups, are often treated non-surgically. Among non-surgical treatments, endoscopic sphincterotomy (ES) has gained increasing acceptance because of its non-invasiveness and relative safety as well as its effectiveness, and its potential applications are widening.1. 2 However, complications of ES reportedly occur in 5 to 10% of patients.1-8 . Nitrates are known to have a vasodilating action. They also act on a range of smooth muscles and effectively relax not only muscles of the gallbladder and the bile ducts but also the sphincter of Oddi.912 Endoscopic removal of small bile duct stones utilizing this nitrate action has been reported without ES,13 which has eliminated the risk of potential complications. In this report, we describe the removal of small common bile duct stones through the combined use of intravenous injection of isosorbide dinitrate and baskets and/or balloons without the use of ES.

Massive rectal bleeding due to ileal tuberculosis

Abstract: A patient with massive rectal bleeding due to ileal tuberculosis is reported. Technetium-99m labelled red blood cell scintigraphy indicated hemorrhage from the ileum, and laparotomy was then carried out. A 70-cm segment of ileum containing ulcers and erosions was resected, and epitheloid granuloma with Langhans-type giant cell was found in the resected specimen. Massive rectal bleeding is considered a rare presenting symptom of intestinal tuberculosis. Intestinal tuberculosis, including small intestinal tuberculosis, although uncommon, should be taken into consideration as a cause of rectal bleeding.

Growth speed of hepatocellular carcinoma. Relationship with arterial vascularity evaluated by US angiography.

病理学的に組織診断されたHCC 41症例41結節について腫瘍容積倍加時間(TVDT)を求め,US angiographyで評価した動脈性vascularityとの関連について検討した.これら結節のTVDTは対数正規分布の傾向にあった.US angiographyにより,25結節はhypervas-cular,7結節はisovascular, 9結節はhypovascularに分類された.Hypervascular HCC (n=25)のTVDTは21～531日に分布し,対数平均は71日,isovascular HCC (n=7)のTVDTは85～699日に分布し,対数平均149日,hypovascular HCC (n=9)のTVDTは125～1,066日に分布し対数平均374日であった.Hypervascular HCCのTVDTはisovascular HCCに比べ,さらにisovascular HCCのTVDTはhypovascular HCCに比べ有意に短かった.これらの結果より,HCCは動脈性vascularityが高いほど発育速度は速いと考えられた.

Cecal Necrosis Due to Ischemic Colitis Mimicking an Abscess on Sonography

Ischemic colitis is a vascular disorder of the colon that causes rectal bleeding and abdominal pain in elderly patients. 1,2 It is classified into gangrenous and nongangrenous forms. Nongangrenous colonic ischemia usually requires only medical treatment and is associated with a good prognosis. In contrast, urgent surgical intervention is required for the treatment of gangrenous colonic ischemia, which is associated with high mortality. 3 Thus, in patients with ischemic colitis, it is especially important to determine whether colonic ischemia is the gangrenous or nongangrenous type. Endoscopic assessment of the colon is the most sensitive and reliable method of evaluating the ischemic colon mucosa 4 ; however, it is not always possible to perform a colonoscopic examination in patients with gangrenous ischemic colitis because of the severe general condition of these patients. Therefore, a noninvasive and rapid examination procedure is necessary for the diagnosis of gangrenous ischemic colitis. In this regard, a sonographic examination may be useful because it can be easily performed even in patients with shock status. In fact, several studies have reported that bowel wall thickening and decreased arterial flow in the affected colon are characteristic findings of patients with nongangrenous ischemic colitis 5-8 ; however, few articles have addressed the sonographic findings of gangrenous colonic ischemia. In this report, we describe the case of a patient with cecal necrosis due to ischemic colitis and discuss its unique sonographic findings.

Vascularity of advanced gastric carcinoma: evaluation by using power Doppler imaging.

Background: We investigated the vascularity of advanced gastric adenocarcinomas by using percutaneous power Doppler imaging.

Measurement of functioning hepatocyte mass via [99mTc]galactosyl-neoglycoalbumin.

Technetium-99m-galactosyl-neoglycoalbumin (TcNGA) is a synthetic radiolabeled ligand specific for hepatic binding protein (HBP), a receptor that resides exclusively on hepatocytes.In vivo measurement of receptor concentration was obtained via kinetic analysis of liver and blood time-activity data obtained during the hepatic clearance of intravenously administered TcNGA. The purpose of this study was to assess receptor concentration as a measure of the functioning hepatocyte mass. Therefore, TcNGA and dualinjection indocyanine green maximal removal rate (ICG Rmax) studies were performed on nine patients with hepatic cirrhosis associated or not with hepatocellular carcinoma. Receptor concentration was compared with ICG Rmax, which is a validated method for the estimation of the functioning hepatocyte mass. The correlation coefficient was 0.76 (P=0.017). It is concluded that HBP concentration ([HPB]o) as measured by functional imaging is a measure of functioning hepatocyte mass. This implies that measurement of an individuals receptor concentration by using nuclear medicine techniques provides an objective index of hepatic functional mass and supports attempts to rigorously evaluate [HBP]o for its clinical efficacy.

A case of localized primary sclerosing cholangitis mimicking intrahepatic bile duct cancer

A 75-year-old woman with chronic hepatitis was regularly followed-up in our hospital. A computed tomography (CT) scan revealed an obviously enlarged intrahepatic bile duct in the posterior branch of the left lateral segment. Percutaneous cholangiography revealed an enlarged posterior branch of the left lateral segment and a narrow stenotic region at the root of this branch. We diagnosed her as having intrahepatic bile duct cancer, and a left lateral segmentectomy of the liver was performed. However, microscopic examination of the resected specimens revealed peribiliary fibrosis in the stenotic bile duct and other areas of the intrahepatic bile duct with no malignant cells. Thus, the final diagnosis was made to be primary sclerosing cholangitis. We must consider primary sclerosing cholangitis in the differential diagnosis of localized stenosis of the intrahepatic bile duct.