Jun Yong Jeong

Palliation of anastomotic obstructions in recurrent gastric carcinoma with the use of covered metallic stents: Clinical results in 25 patients

BACKGROUND The purpose of this study was to investigate the technical feasibility and the clinical effectiveness of the placement of covered self-expandable metallic stents for the treatment of anastomotic obstructions in recurrent gastric carcinoma. METHODS With fluoroscopic guidance, covered stents were placed in 25 patients with recurrent gastric carcinoma for the palliation of obstructions at anastomotic sites (14 gastrojejunostomy, 11 esophagojejunostomy). All patients had severe nausea and recurrent vomiting before the stent placement. RESULTS Stent placement was technically successful in 24 patients (96%). After stent placement, symptoms improved in all 24 patients. During the follow-up of 2 to 65 weeks (mean, 13.7 weeks), stent migration occurred in 1 patient 16 days after the procedure. He needed percutaneous catheter drainage because of an abscess, which was followed by esophagojejunostomy site rupture during a second stent trial. Stricture recurred in 4 patients because of tumor overgrowth 10 to 55 weeks after the procedure; all patients underwent coaxial placement of a second stent and had good oral intake. CONCLUSIONS The placement of covered expandable metallic stents seems to be both technically feasible and an effective means for the palliation of anastomotic obstructions in recurrent gastric carcinoma. This procedure can be considered to be the primary choice for the palliation in those patients.

CT Differentiation of cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis.

OBJECTIVE The objective of our study was to determine useful CT findings for differentiating cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis. MATERIALS AND METHODS CT images of 30 patients with hepatolithiasis and pathologically proven cholangiocarcinoma (n = 14) or periductal fibrosis (n = 16) were retrospectively reviewed. Helical CT scans were obtained before, 30 seconds after, and 65 seconds after the start of contrast material injection. Analysis of CT findings included evaluation for the presence of periductal soft-tissue density, bile duct wall thickening at the stricture site, ascites, portal vein obliteration, lymph node enlargement, and a duct stone; assessment of the degree of ductal dilatation; and evaluation of the enhancement pattern of periductal lesions, thickened ductal wall, and hepatic parenchyma. The CT attenuation coefficients of the thickened ductal wall and adjacent normal-looking bile duct were measured on images obtained during each phase. Among these findings, statistically significant variables were determined using the Fishers exact test and Students t test. Sensitivity and specificity values of the CT criteria were also calculated. RESULTS The presence of periductal soft-tissue density (p = 0.002), higher enhancement of the duct than adjacent bile duct on portal venous phase images (p = 0.008), ductal wall thickening (p = 0.026), portal vein obliteration (p = 0.031), and lymph node enlargement (p = 0.031) were found to be the significant findings for differentiating cholangiocarcinoma from fibrosis in patients with hepatolithiasis. When any two or more of these five criteria were used in combination, we could identify 100% of the patients with cholangiocarcinoma but only 12.5% of the patients with fibrosis. CONCLUSION Cholangiocarcinoma in patients with hepatolithiasis can be diagnosed using specific CT criteria.

Ruptured Corpus Luteal Cyst: CT Findings

Objective To evaluate the CT findings of ruptured corpus luteal cysts. Materials and Methods Six patients with a surgically proven ruptured corpus luteal cyst were included in this series. The prospective CT findings were retrospectively analyzed in terms of the size and shape of the cyst, the thickness and enhancement pattern of its wall, the attenuation of its contents, and peritoneal fluid. Results The mean diameter of the cysts was 2.8 (range, 1.5-4.8) cm; three were round and three were oval. The mean thickness of the cyst wall was 4.7 (range, 1-10) mm; in all six cases it showed strong enhancement, and in three was discontinuous. In five of six cases, the cystic contents showed high attenuation. Peritoneal fluid was present in all cases, and its attenuation was higher, especially around the uterus and adnexa, than that of urine present in the bladder. Conclusion In a woman in whom CT reveals the presence of an ovarian cyst with an enhancing rim and highly attenuated contents, as well as highly attenuated peritoneal fluid, a ruptured corpus luteal cyst should be suspected. Other possible evidence of this is focal interruption of the cyst wall and the presence of peritoneal fluid around the adnexa.

MR findings of renal cortical necrosis.

Purpose Evaluating the MR findings of renal cortical necrosis was the purpose of this study. Method Eight series of T1-/T2-weighted (n = 8) and contrast-enhanced T1-weighted (n = 4) MR images in six patients with renal cortical necrosis diagnosed by renal biopsy (n = 4) or on clinical grounds (n = 2) were reviewed. In those who had follow-up MRI (n = 2) or comparable CT (n = 3), interval changes of MR findings and comparison with CT images were done. Results Swollen kidney with dark signal intensity rim involving the inner cortex and column of Bertin was noted on T2-and T1-weighted images. It was more conspicuous on T2-weighted images. The lesion did not enhance and was differentiated from uninvolved renal parenchyma. In the follow-up MRI, thickened dark signal intensity was more prominent and proved to be calcification or fibrosis. Conclusion MRI, especially T2-weighted and contrast-enhanced T1-weighted imaging, was helpful in evaluating renal cortical necrosis.

Hepatic attenuation differences associated with obstruction of the portal or hepatic veins in patients with hepatic abscess

OBJECTIVE The purpose of our study was to determine the nature of the association between the attenuation difference of the hepatic parenchyma surrounding an abscess and obstruction of the regional portal vein or of the hepatic vein. MATERIALS AND METHODS Helical CT scans of 60 patients with hepatic abscess were analyzed for the presence of complete or partial obstruction of the portal or hepatic veins and for attenuation differences in the surrounding parenchyma. Clinical (age, sex, underlying disease, and microorganism) and CT (obstruction of the portal or hepatic vein and number, location, and size of abscesses) findings were analyzed statistically for possible associations with each of regional parenchymal hyper- and hypoattenuation by using the chi-square test and multivariate logistic regression analysis. RESULTS Regional parenchymal hyperattenuation was identified in 40 patients (67%). More patients with portal vein obstruction showed regional parenchymal hyperattenuation than patients without portal vein obstruction (22/27 patients vs 18/33, p = 0.028), and more patients with hepatic vein obstruction showed regional parenchymal hypoattenuation than those without hepatic vein obstruction (11/21 vs 3/39, p = 0.0003). Multivariate logistic regression analysis showed that portal venous obstruction was the only statistically significant predictor of regional parenchymal hyperattenuation (p = 0.032; odds ratio, 3.7) and that parenchymal hypoattenuation was associated with hepatic venous obstruction (p = 0.001; odds ratio, 44.9). CONCLUSION Parenchymal hypo- and hyperattenuation are frequently observed in the hepatic region surrounding an abscess on dynamic CT. Moreover, these parenchymal attenuation differences are associated with regional portal or hepatic vein obstruction.

Three-dimensional Ultrasonography Using the Minimum Transparent Mode in Obstructive Biliary Diseases Early Experience

To assess the feasibility of three‐dimensional ultrasonography using the minimum transparent mode in patients with obstructive biliary disease.