Masumi Kadoya

JSH Consensus-Based Clinical Practice Guidelines for the Management of Hepatocellular Carcinoma: 2014 Update by the Liver Cancer Study Group of Japan

The Clinical Practice Guidelines for the Management of Hepatocellular Carcinoma proposed by the Japan Society of Hepatology was updated in June 2014 at a consensus meeting of the Liver Cancer Study Group of Japan. Three important items have been updated: the surveillance and diagnostic algorithm, the treatment algorithm, and the definition of transarterial chemoembolization (TACE) failure/refractoriness. The most important update to the diagnostic algorithm is the inclusion of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging as a first line surveillance/diagnostic tool. Another significant update concerns removal of the term “lipiodol” from the definition of TACE failure/refractoriness.

Dynamic computed tomography during arterial portography: the most sensitive examination for small hepatocellular carcinomas

Surgicalhe efficacy of dynamic sequential CT with table incrementation during arterial portography (DSCTI-AP) in the detection of small hepatocellular carcinomas (HCC) (less than 3 cm in diameter and less than three in number) was analyzed in comparison with other imaging methods including radionuclide (RN) liver scans, ultrasound (US), CT, selective celiac angiography (SCA), and infusion hepatic angiography (IHA). The sensitivity of each study in detecting 19 cases of small HCC was as follows: RN, 16%; US, 63%; CT, 58%; SCA, 58%; IHA, 83%; and DSCTI-AP, 95%. Three of 19 cases were diagnosed only by DSCTI-AP and one case that could not be visualized by DSCTI-AP was opacified by IHA. Dynamic sequential CT with table incrementation during arterial portography was superior to IHA in visualizing small HCCs.

Characteristic findings in images of extra-pancreatic lesions associated with autoimmune pancreatitis.

PURPOSE Autoimmune pancreatitis is a unique form of chronic pancreatitis characterized by a variety of extra-pancreatic involvements which are frequently misdiagnosed as lesions of corresponding organs. The purpose of this study was to clarify the diagnostic imaging features of extra-pancreatic lesions associated with autoimmune pancreatitis. MATERIALS AND METHODS We retrospectively analyzed diagnostic images of 90 patients with autoimmune pancreatitis who underwent computer-assisted tomography, magnetic resonance imaging, and/or gallium-67 scintigraphy before steroid therapy was initiated. RESULTS AIP was frequently (92.2%) accompanied by a variety of extra-pancreatic lesions, including swelling of lachrymal and salivary gland lesions (47.5%), lung hilar lymphadenopathy (78.3%), a variety of lung lesions (51.2%), wall thickening of bile ducts (77.8%), peri-pancreatic or para-aortic lymphadenopathy (56.0%), retroperitoneal fibrosis (19.8%), a variety of renal lesions (14.4%), and mass lesions of the ligamentum teres (2.2%). Characteristic findings in CT and MRI included lymphadenopathies of the hilar, peri-pancreatic, and para-aortic regions; wall thickening of the bile duct; and soft tissue masses in the kidney, ureters, aorta, paravertebral region, ligamentum teres, and orbit. CONCLUSIONS Recognition of the diagnostic features in the images of various involved organs will assist in the diagnosis of autoimmune pancreatitis and in differential diagnoses between autoimmune pancreatitis-associated extra-pancreatic lesions and lesions due to other pathologies.

Prognostic significance of high-resolution CT findings in small peripheral adenocarcinoma of the lung: a retrospective study on 64 patients

OBJECTIVE We studied the prognostic importance of high-resolution CT (HRCT) findings in lung adenocarcinomas. PATIENTS AND METHODS HRCT findings (lesion size, percentage of ground-glass opacity (GGO) areas of lesion, and presence or absence of lobulation, coarse spiculation, air space, pleural tag, and multiplicity of lesion), clinical data (age and surgical method), and pathologic findings (tumor subtypes and presence or absence of nodal metastasis) in 64 consecutive patients with 64 peripheral adenocarcinomas of 20 mm or less (mean, 13 mm), including 36 women and 28 men with a mean age of 64 years were analyzed and correlated with survival of the patients using Kaplan-Meier method and stepwise Cox proportional hazards modeling. Follow-up periods of the patients ranged from 6 to 45 months (mean, 22 months). Tumors were classified into six subtypes (types A-F) according to tumor growth patterns defined by Noguchi et al. RESULTS Six (9%) of the 64 patients died of lung cancer. In univariate analyses, a significant difference was noted for lesion size (P=0.043), the percentage of GGO areas (P=0.005), and tumor subtypes (P=0.006). Lesion size of <15 mm (n=35), a lesion with GGO areas of >57% (n=36), and type A (n=16) or type B adenocarcinomas (n=16) indicated a significantly better survival. In multivariate analyses using these three parameters as independent variables, the percentage of GGO areas was the only significant independent factor for survival (P=0.044, relative risk=0.95). CONCLUSION GGO areas measured on HRCT may have an independent prognostic significance of small adenocarcinomas of the lung.

Quantitative Evaluation of Liver Function with Use of Gadoxetate Disodium–enhanced MR Imaging

PURPOSE To determine whether liver function correlating with indocyanine green (ICG) clearance could be estimated quantitatively from gadoxetate disodium-enhanced magnetic resonance (MR) images. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Twenty-three consecutive patients who underwent an ICG clearance test and gadoxetate disodium-enhanced MR imaging with the same parameters as were used for a preoperative examination were chosen. The hepatocellular uptake index (HUI) from liver volume (V(L))and mean signal intensity of the liver on contrast-enhanced T1-weighted images with fat suppression (L(20)) and mean signal intensity of the spleen on contrast-enhanced T1-weighted images with fat suppression (S(20)) on 3D gradient-echo T1-weighted images with fat suppression obtained at 20 minutes after gadoxetate disodium (0.025 mmol per kilogram of body weight) administration was determined with the following equation: V(L)[(L(20)/S(20)) - 1]. The correlation of the plasma disappearance rate of ICG (ICG-PDR) and various factors derived from MR imaging, including HUI, iron and fat deposition in the liver and spleen, and spleen volume (V(S)), were evaluated with stepwise multiple regression analysis. The difference between the ratio of the remnant HUI to the HUI of the total liver (rHUI/HUI) and ratio of the liver remnant V(L) to the total V(L) (rV(L)/V(L)) was evaluated in four patients who had segmental heterogeneity of liver function. RESULTS HUI and V(S) were the factors significantly correlated with ICG-PDR (R = 0.87). The mean value and its 95% confidence interval were 0.18 and 0.01 to 0.34, respectively, for the following calculation: (rHUI/HUI) - (rV(L)/V(L)). CONCLUSION The liver function correlating with ICG-PDR can be estimated quantitatively from the signal intensities and the volumes of the liver and spleen on gadoxetate disodium-enhanced MR images, which may improve the estimation of segmental liver function.

Delayed enhancement of fibrotic areas in hepatic masses : CT-pathologic correlation

We report a histological analysis of the areas of high density in the postequilibrium and delayed phase CT in 43 focal hepatic lesions. The cases consisted of 16 cholangiocellular carcinomas, 9 hepatocellular carcinomas (including a sclerosing type of hepatocellular carcinoma and a combined hepatocellular-cholangiocellular carcinoma), 13 metastases, 2 granulomas, an inflammatory pseudotumor, a malignant lymphoma, and an epithelioid hemangioendothelioma. Computed tomography was performed after hepatic angiography using 40-50 g iodine and arteriographic CT using 35 g iodine. The areas of delayed enhancement corresponded histologically to fibrotic tissues, from inflammatory change to extensive fibrosis.

Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography

BackgroundFluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer. Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancreatic cancer, we attempted to clarify the differences in FDG-PET findings between the two conditions.MethodsWe compared FDG-PET findings between 15 patients with autoimmune pancreatitis and 26 patients with pancreatic cancer. The findings were evaluated visually or semiquantitatively using the maximum standardized uptake value and the accumulation pattern of FDG.ResultsFDG uptake was found in all 15 patients with autoimmune pancreatitis, whereas it was found in 19 of 26 patients (73.1%) with pancreatic cancer. An accumulation pattern characterized by nodular shapes was significantly more frequent in pancreatic cancer, whereas a longitudinal shape indicated autoimmune pancreatitis. Heterogeneous accumulation was found in almost all cases of autoimmune pancreatitis, whereas homogeneous accumulation was found in pancreatic cancer. Significantly more cases of pancreatic cancer showed solitary localization, whereas multiple localization in the pancreas favored the presence of autoimmune pancreatitis. FDG uptake by the hilar lymph node was significantly more frequent in autoimmune pancreatitis than in pancreatic cancer, and uptake by the lachrymal gland, salivary gland, biliary duct, retroperitoneal space, and prostate were seen only in autoimmune pancreatitis.ConclusionsFDG-PET is a useful tool for differentiating autoimmune pancreatitis from suspected pancreatic cancer, if the accumulation pattern and extrapancreatic involvement are considered. IgG4 measurement and other current image tests can further confirm the diagnosis.

Hilar and Pancreatic Gallium-67 Accumulation is Characteristic Feature of Autoimmune Pancreatitis

Introduction and Aims Autoimmune pancreatitis is characterized by severe lymphocytic inflammation, suggesting that gallium-67 scintigraphy provides a useful tool for detecting characteristic lesions of this disease, because gallium-67 concentrates in lymphoid cells. We tried to determine whether gallium-67 accumulates in the characteristic lesions. Methodology We performed gallium-67 scintigraphy in 24 patients with autoimmune pancreatitis before and after 4 weeks of corticosteroid therapy and determined the factors associated with positive images. Results Sixteen patients (67%) had marked gallium-67 accumulation in the pancreas before corticosteroid therapy and negative images after 4 weeks of therapy, and they had significantly higher serum IgG4 values than did those without gallium-67 accumulation (median, 758 mg/dL versus 329 mg/dL; p = 0.011). Marked hilar gallium-67 accumulation was found in 16 patients (67%) and was also associated with significantly higher serum IgG4 values than did those without it (median, 758 versus 239 mg/dL; p = 0.0044). Among 16 patients with positive hilar images, 12 had positive pancreatic uptake and 5 had both pancreatic and salivary gland uptakes. Conclusions Hilar and pancreatic accumulation of gallium-67 is a characteristic feature of autoimmune pancreatitis during the active stage of the disease, when IgG4 serum levels are high.

Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015.

Japanese (JPN) guidelines for the management of acute pancreatitis were published in 2006. The severity assessment criteria for acute pancreatitis were later revised by the Japanese Ministry of Health, Labour and Welfare (MHLW) in 2008, leading to their publication as the JPN Guidelines 2010. Following the 2012 revision of the Atlanta Classifications of Acute Pancreatitis, in which the classifications of regional complications of pancreatitis were revised, the development of a minimally invasive method for local complications of pancreatitis spread, and emerging evidence was gathered and revised into the JPN Guidelines.

Height of normal pituitary gland on MR imaging: age and sex differentiation

Measurement of the pituitary height was performed on magnetic resonance (MR) images of 213 subjects with no known or suspected pituitary and/or hypothalamic disorders. Midsagittal, T1-weighted images were used for measurements and mean heights in each age and sex group were obtained. In the 10 to 69 year range, the pituitary heights were greater in females than in males. The groups of 0-9 years of both genders showed the minimum mean pituitary height. The maximum of the mean height was observed in the 10 to 19 year age groups of both genders. The height gradually decreased with increasing age after age 20 years. There were no subjects with a height of greater than or equal to 9.0 mm in females or greater than or equal to 8.0 mm in males. There was a marked discrepancy between MR and autopsy findings in the older subjects, probably related to the upward concavity that is often encountered in the aged gland. Because of this concavity, the midsagittal MR measurement will induce underestimation of the whole gland.