In Ho Cha

Endovenous Laser Ablation of the Incompetent Small Saphenous Vein with a 980-nm Diode Laser: Our Experience with 3 Years Follow-up

PURPOSE To demonstrate the long-term treatment outcomes of endovenous laser ablation (EVA) of incompetent small saphenous veins (SSV) with a 980-nm diode laser. MATERIALS AND METHODS Eighty-four patients (96 limbs), with varicose veins and reflux in the SSV on duplex ultrasound examination, were treated with a 980-nm diode laser under ultrasound- or fluoroscopy-guidance. Patients were evaluated at 1 week and 1, 3, 6 months, 1 year and yearly thereafter. RESULTS In the 96 limbs, the technical success rate was 100%. The SSV remained closed in 89 of 93 limbs (96%) after 1 month, all of 82 limbs after 6 months, 77 limbs after 1 year, 71 limbs after 2 years and 55 limbs after 3 years. In four limbs where recanalisation was observed, repeat EVA was done resulting in successful obliteration of the SSV. No major complication occurred however bruising (27%), tightness or pain (13%) and paraesthesia (4.2%) were observed. CONCLUSION Endovenous laser ablation with a 980-nm laser wavelength is an easy and safe procedure in incompetent SSVs. After successful treatment, there is a very low rate of recanalisation of the SSV, which suggests that the procedure will provide lasting results.

Preoperative evaluation of gastric cancer: value of spiral CT during gastric arteriography (CTGA).

AbstractBackground: 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.

Inflammatory myofibroblastic tumor of the stomach with peritoneal dissemination in a young adult: imaging findings.

Inflammatory myofibroblastic tumors are lesions that most often affect young adults and children. These tumors have been found in numerous extrapulmonary sites but rarely in the stomach. It is unknown whether this process is reactive or neoplastic. They are infiltrative lesions and often extend through the gastric wall, sometimes reaching adjacent organs including the esophagus, duodenum, peritoneal cavity, spleen, pancreas, and liver. These features mimic malignancy on endoscopy and radiology. We report the ultrasound, color Doppler ultrasound, and helical computed tomographic findings of a gastric inflammatory myofibroblastic tumor with peritoneal dissemination in a young adult. To our knowledge, this is the first report of color Doppler ultrasound and helical computed tomographic findings of this rare disease entity.

An interesting hepatic mass: Splenosis mimicking a hepatocellular carcinoma (2003:9b)

We report a splenosis mimicking hepatocellular carcinoma in a patient with chronic liver disease. Knowledge of these imaging findings, including helical CT, angiography, CT hepatic arteriogram, CT arterioportogram, and iodized-oil CT, may obviate unnecessary surgery.

Hepatocellular carcinoma in extrahepatic bile ducts

An elongated solid lesion observed on ultrasonography and CT in the biliary tree causing a smooth filling defect on cholangiography was observed in 2 patients. No tumor was observed in the liver parenchyma either on radiography or at operation. Histopathology showed hepatocellular carcinoma. After removal of the intraductal tumors, recurrence was observed in 2 and 6 months, respectively.

Analysis of adjacent fracture after percutaneous vertebroplasty: does intradiscal cement leakage really increase the risk of adjacent vertebral fracture?

ObjectiveThe purpose of this study was to evaluate the incidence and risk factors associated with adjacent vertebral fracture after percutaneous vertebroplasty (PVP) to treat osteoporotic vertebral compression fractures. We also investigated the effect of intradiscal cement leakage on adjacent vertebral fracture formation after PVP.Materials and methodsFrom January 2003 to March 2009, 188 patients (163 women, 25 men; mean age, 70.9 years; range, 42–92 years) who underwent 214 PVP sessions at 351 levels for osteoporotic vertebral compression fractures were retrospectively enrolled in this study. The effect of intradiscal cement leakage on new adjacent vertebral fracture formation after PVP was evaluated. Possible other risk factors were also analyzed using univariate and multivariate methods. The risk factors included age, gender, mean bone mineral density (BMD), the vertebral level treated, presence of an intravertebral cleft or cyst before treatment, kyphosis angle, wedge angle, and the injected cement volumes.ResultsDuring the follow-up periods, new adjacent vertebral fractures developed in 36 (10.3%) of 351 treated levels. For 91 (25.9%) levels, intradiscal cement leakage was detected on procedural fluoroscopic radiographs. There was no statistically significant association between intradiscal cement leakage and new adjacent vertebral compression fracture (p = 0.789). Among the other risk factors, only the vertebral levels treated, especially the thoracolumbar junction, showed a significant relationship to new adjacent vertebral fractures (univariate analysis, p = 0.037; multivariate analysis, p = 0.043).ConclusionsIntradiscal cement leakage does not seem to be related to subsequent adjacent vertebral compression fracture in patients who underwent PVP for treatment of an osteoporotic compression fracture. The thoracolumbar location of the initial compression fracture is the only factor correlated with an adjacent vertebral fracture after PVP.

Hepatocellular carcinoma in an ectopic liver: CT findings

Hepatocellular carcinoma (HCC) in an ectopic liver is very rare and its CT findings have never been reported. We present an ectopic HCC between the spleen and left diaphragm, mimicking a splenic neoplasm on the CT scan. A follow up CT at seven months postoperatively revealed multiple recurrent HCCs in the mother liver.

Magnetic resonance evaluation of fibrovascular ingrowth into porous polyethylene orbital implant.

We assessed the fibrovascular ingrowth into porous orbital implant with MRI. Twelve cases underwent T1WI, T2WI, Gd-enhanced T1WI, and Short Tau Inversion Recovery (STIR) images. Gd-enhanced T1WI showed homogeneous enhancement (n=4), peripheral and posterior part enhancement (n=7), and anterior part enhancement (n=1) of implants. High signal intensity portions on STIR images coincided with the enhancing portions on Gd-enhanced T1WI. Gd-enhanced T1WI is an excellent method for assessment of fibrovascular ingrowth into orbital implant and STIR images may be a comparable method to Gd-enhanced T1WI.

Contrast-enhanced power Doppler US: Is it useful in the differentiation of gallbladder disease? - Preliminary results

Thirteen patients with gallbladder disease underwent power Doppler ultrasound (PDUS) before and after microbubble contrast agent injection. Lesion and liver bed vascularity was evaluated. Pathological diagnoses in nine patients were two acute cholecystitis, four chronic inflammation, one adenoma and two adenocarcinoma. Two cases of cancer were included on clinical and radiological findings. Two cases were excluded because no pathologic diagnosis was available. Liver bed hyperemia was noted only in acute cholecystitis. Contrast-enhanced PDUS was superior to nonenhanced PDUS in the demonstration of vascularity of gallbladder diseases. However, contrast-enhanced PDUS has limited value in the differentiation.

Hepatic involvement in hypereosinophilic syndrome: value of portal venous phase imaging

Abstract. US, portal venous phase CT, and MRI-CSE (MRI with conventional spin-echo sequence) findings in three cases of hepatic involvement in hypereosinophilic syndrome are presented. These showed varied imaging findings, but portal venous phase CT showed multiple, poorly marginated, and hypodense hepatic lesions in all three cases. The result suggested that portal venous phase CT is the optimal method for depicting hepatic involvement.