Yuriko Okino

Mucin-producing carcinoma of the gallbladder: Imaging demonstration in four cases

We report four cases of mucin-producing carcinoma of the gallbladder (three papillary adenocarcinomas and one mucinous carcinoma), with an emphasis on imaging features. Our findings suggest that when a papillary protrusion or thickened wall, including cystic areas and/or calcifications, is seen radiologically in the enlarged gallbladder, mucin-producing carcinoma of the gallbladder should be included in the differential diagnosis.

Transportal Intravariceal Sclerotherapy with N-Butyl-2-Cyanoacrylate for Gastric Varices

Four patients with gastric varices without catheterizable draining veins through a systemic vein were treated with transportal intravariceal sclerotherapy with n-butyl-2-cyanoacrylate (NBCA). In all patients, the gastric varices were successfully obliterated with 2-5 mL of NBCA-lipiodol mixture injected via a microcatheter introduced into the varices with transhepatic or transileocolic portal venous access. No complications related to the procedure were encountered. Follow-up gastroendoscopy showed disappearance (n = 3) or marked decrease (n = 1) of the varices. Neither recurrent gastric varices nor variceal bleeding were observed during the follow-up period (6-46 months). Transportal intravariceal sclerotherapy is useful for obliteration of gastric varices in selected cases.

Hepatocellular carcinoma: prediction of blood supply from right inferior phrenic artery by multiphasic CT.

Objective: Recurrent hepatocellular carcinoma (HCC) often occurs with extrahepatic arterial supply (parasitic supply), essentially due to liver intraarterial chemoembolization, which could potentially hamper retreatment. The right inferior phrenic artery (RIPA) is the most frequent extrahepatic feeding artery. We investigated computed tomography (CT) findings of parasitic supply by the RIPA, and discuss the utility of multiphasic CT for prediction of parasitic supply from RIPA. Method: Medical records, CT scans, and angiograms in 20 patients with HCC fed by RIPA were reviewed. Forty‐two patients with HCC but without parasitic supply were enrolled as the control group. After injection of contrast medium (300 mg I/mL) at a rate of 3 mL/s (total amount, 100 mL), CT images were obtained at 30 seconds, 60 seconds, and 150 seconds with scanning parameters of 7‐mm collimation, 1:1 pitch, and 3.5‐mm reconstruction. Two radiologists evaluated the previous treatment, patency of the hepatic arteries, location of tumors, and detectability and diameter of the RIPA. Results: CT demonstrated at least one portion of RIPA in all patients in both groups. The distal portions of RIPA were detected on CT more frequently in the parasitic group (75%) than in the control group (7.1%). The mean diameter of the RIPA in the parasitic group was 2.3 mm (range; 1.6–3.8), and was larger than that of the control group (mean; 1.3 mm and range; 0–4.1mm) with statistical significance (P < 0.01). Conclusions: Multiphasic CT could demonstrate the presence of parasitic supply to HCCs from RIPA. Visualization of RIPA at the distal portion on CT would be a clue of parasitic supply from RIPA. Index Terms: right inferior phrenic artery, hepatocellular carcinoma, parasitic supply, computed tomography

Internal hernias after abdominal surgeries: MDCT features

As less-invasive treatments for small bowel obstruction, such as laparoscopic surgery or small incision therapy, have become common, there is a growing demand for preoperative assessment of the cause and location of the small bowel obstruction. Thus, the role of computed tomography (CT) in the evaluation of small bowel obstruction is expanding. CT imaging of internal hernias (IHs) has been extensively described and is well established; however, CT imaging of IH after abdominal surgeries is not well recognized because of their anatomical complexity. The aims of this pictorial review are (1) to evaluate the causes of internal IHs in relation to previous abdominal surgery (e.g., IH associated with Roux-en-Y reconstruction, Billroth II reconstruction, peritoneal adhesive band, perineal hernia, and IH after gynecological procedures), (2) to demonstrate the spectrum of imaging findings on multidetector CT (MDCT), and (3) explain the key features for CT diagnosis of IHs related to previous surgical procedures, with emphasis on the multi-planar reformation (MPR) image. We also demonstrate the dynamic changes in the progression of mesenteric strangulation revealed by CT. Understanding the imaging appearance on MDCT can help radiologists guide therapy for patients with a small bowel obstruction after abdominal surgery.

Anatomical variations of peripancreatic veins and their intrapancreatic tributaries: multidetector-row CT scanning

BackgroundTo date the anatomy of the intrapancreatic and peripancreatic veins using multidetector-row CT (MDCT) was not assessed. The object of this study is to establish 3D CT anatomy of these veins.MethodsA total of 100 consecutive patients who underwent abdominal triple-phase CT using 16-detector MDCT were retrospectively reviewed. The anatomical variations of the peripancreatic and intrapancreatic veins were assessed.ResultsAmong the 100 cases, 42 cases (42%) had a single posterior superior pancreaticoduodenal vein crossing the ventral side of the common bile duct, while 30 cases (30%) had an uncinate vein running upward behind the medial side of the pancreatic. In the pancreatic head and body/tail area, there were many small veins that directly entered the superior mesenteric or splenic vein. In 59 cases (59%), the centro-inferior pancreatic vein ran transversely along the inferior surface of the pancreatic body and drained the anterior or inferior parts of the pancreatic body, mainly into the splenic vein.ConclusionMany variations exist in the running patterns of intrapancreatic veins as well as peripancreatic veins. Recognition of abnormalities of intrapancreatic veins on CT in the light of normal CT anatomy may contribute to the interpretation of pathological conditions of the pancreas.