Masahiro Iio

Benefit of Transcatheter Arterial Embolization for Ruptured Hepatocellular Carcinoma Complicating Liver Cirrhosis

In 6 patients with spontaneous rupture of hepatocellular carcinoma complicating liver cirrhosis, but with no occlusion of the main portal trunk, transcatheter arterial embolization was performed within 7 days of the rupture. All 6 patients were thought to be inoperable because of shock state or severe hepatic dysfunction. In all 6 patients, the progressive decrease in the hematocrit ceased soon after the embolization. Five patients survived for 31-168 days after the embolization; 1 patient who developed septicemia died 10 days later. We conclude that transcatheter arterial embolization is beneficial as a procedure of first choice for ruptured hepatocellular carcinoma when the portal blood flow is maintained.

Case report: Enormous intrahepatic communication between the portal vein and the hepatic vein

A case of enormous intrahepatic shunt between the portal vein and the hepatic vein is described. The lesion was successfully treated by embolisation using stainless steel coils on two occasions, after demonstration by percutaneous transhepatic portography (PTP).

Scintigraphic manifestation of fibrous dysplasia

Scintigraphic manifestations of fibrous dysplasia were analyzed in 59 lesions of 26 patients (12 monostotic, 14 polystotic). Bone imaging with Tc-99m MDP revealed a high percentage of increased uptake of radioisotope in the lesions of fibrous dysplasia. Four (14%) of 29 cystic lesions and two (7%) of 30 lesions with the appearance of ground glass showed no increase in radioisotope uptake, although roentgenograms showed marked changes. Therefore, care must be taken in the diagnosis of fibrous dysplasia with bone imaging alone. Nuclear methods, however, are indispensable in evaluating the dynamic aspects of bone mineral behavior and in demonstrating disease where none was suspected, or in visualizing polyostotic involvement in those cases where only monostotic disease was suspected clinically. It is concluded that both scintigrams and roentgenograms are complementary procedures in the diagnosis of fibrous dysplasia.

Enterogenous cyst of cervical spine: clinical and radiological aspects (including CT and MRI).

SummaryEnterogenous cysts are relatively rare causes of spinal cord compression. A case of enterogenous cyst causing compression of spinal cord at C2–3 is presented. Radiological findings, including MRI, are discussed.

Fast Spin Echo Imaging with Suspended Respiration: Gadolinium Enhanced MR Imaging of Liver Tumors

Magnetic resonance (MR) imaging of 43 patients with hepatic tumor was performed during suspended respiration using a fast scan spin echo (SE) technique (SE 200/40) with a single excitation. The resulting images were superior in terms of image quality to conventional ones. Due to the lack of soft tissue contrast, 38 patients received Gd-diethylenetriaminepentaacetic acid (DTPA) at 0.05 mmol/kg and serial scanning (CE-MR) was repeated. Twelve of 14 hepatomas showed isointensity or slightly reduced intensity compared with the liver in unenhanced MR. All metastases (nine patients) showed low signal intensity that was statistically significant (p less than 0.001) in differentiating between hepatomas and metastatic liver tumors. With contrast enhanced MR, both hepatomas and metastases showed changes that cannot be further classified until more cases have been examined. In all 12 cavernous hemangioma cases, Gd-DTPA pooling was observed with extremely high contrast, which was a pathognomonic sign. In fact, four cavernous hemangiomas in two patients with a diameter of 1.0 cm were successfully imaged.

Detection of Hepatic Shunts by the Use of 131I-Macroaggregated Albumin

Summary By scintiscanning the lung and liver following the injection of 131 I-macroaggre-gated albumin ( 131 I-MAA) into the spleen, the presence and degree of extra- and intrahepatic shunts were studied. On this basis, 13 patients among 15 cirrhotics and 1 patient with liver fibrosis had collateral circulation in the splenoportal system. Three patients with hemolytic anemias, 4 with hepatitis, and 2 with cirrhosis had no shunts. Shunt indices calculated from liver and lung counts in scintigrams ranged from 18 to 90 in patients with cirrhosis of the liver with shunts and below 6 in patients without shunts.The radioactivity accumulation curves were recorded over the liver and lung following MAA injection to detect the presence of intrahepatic shunts. An initial hump of the liver MAA accumulation curve was observed in 7 cirrhotics, suggesting the presence of intrahepatic shunts.The MAA transit time from spleen to liver was almost the same whether or not cirrhosis was present. Spleen to lung time through collateral veins ranged widely.The application of 131 I-MAA was considered to be an easy and useful method for the detection and semiquantitation of intra- and extrahepatic shunts in cirrhosis of the liver.

MR imaging of hepatoma treated by embolization

The magnetic resonance findings of two hepatomas treated by embolization are presented. The T2-weighted spin echo images showed an increase in signal intensity in the tumor after embolization. This phenomenon corresponded to a decrease in tumor density on CT and to necrosis observed histologically. Magnetic resonance also demonstrated gas bubbles as low signal foci within the embolized tumor.

Portosystemic collaterals on MR imaging

Fourteen patients with various portosystemic collaterals (seven esophageal varices, three paraumbilical veins, two splenorenal shunts, and two mesenteric varices) were imaged with magnetic resonance (MR) imaging using a superconducting imager. Collateral pathways were demonstrated as tortuous structures of no or low signal intensity on spin-echo image, and flow related enhancement did not cause any difficulty in evaluation. Direct sagittal images are especially useful for paraumbilical vein and coronal images for esophageal and mesenteric varix. The clinical role of MR in the assessment of portosystemic collaterals is discussed also in comparison with CT and ultrasound.

ST-T isointegral analysis of exercise stress body surface mapping for identifying ischemic areas in patients with angina pectoris

ST-T isointegral analysis of body surface mapping was used in an attempt to localize ischemic areas on exercise tests. In 28 patients with angina pectoris and 10 healthy subjects, body surface potential was recorded with 87 leads, and ST isopotential and ST-T isointegral maps were constructed. In all 10 healthy subjects, the basic pattern of the ST-T isointegral map showed no significant change after exercise. In 23 of 28 patients with angina pectoris (82%), alterations in the ST-T isointegral map after exercise were observed. They were divided into four types (anterior, inferoposterior, lateral, and global) according to the distribution of negative values, which were well correlated with the extent of ischemic area determined by thallium myocardial scintigraphy and coronary angiography. The postexercise ST-T isointegral map was normalized after administration of nitroglycerin in four of five patients. In five patients (18%) who did not show abnormalities on the postexercise ST-T isointegral map, the magnitude of maximal ST depression was significantly smaller than that observed in the other 23 patients with angina pectoris (0.14 vs 0.23 mV on the average, p less than 0.05). It was concluded that the exercise test with ST-T isointegral mapping is a new method for noninvasive detection of location and severity of ischemic regions.

MR imaging of portal vein thrombus in hepatocellular carcinoma.

This report describes the magnetic resonance (MR) demonstration of portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC). In two cases of HCC with PVTT diagnosed by angiography, MR demonstrated PVTT as areas of increased MR signal in the portal vein. Our limited experience suggests the potential utility of MR imaging for diagnosis of PVTT.