Magnetic resonance tomography, computed tomography and ultrasonic diagnosis of hemangiomas of the liver

The paper is concerned with the potentialities of modern radiation methods in the diagnosis of liver hemangiomas. USI, CT, angiography and MR-tomography (MRT) were used for investigation of 64 patients with liver hemangiomas. The diagnostic potentialities and the role of each of the above methods in the diagnostic algorithm in liver hemangiomas were studied. The results of the investigation have shown that MRT possesses a higher informative value than USI and CT in the diagnosis of liver hemangiomas and can even replace angiography in the verification of diagnosis.     

Radiologic diagnosis of focal liver lesions

The paper is concerned with analysis of the results of combined investigation of 54 patients with focal liver lesions. USI, CT, angiography and radionuclide scintigraphy were performed. The diagnostic efficacy of USI and CT was 94.4 and 90.7%, respectively, that of scintigraphy was 68.5%, that of angiography was 55.5%. A scheme of the effective use of radiation methods in the diagnosis of sizable formations of the liver was worked out.     

Potentialities of ultrasound and computed tomography in the diagnosis of metastases of lung cancer in the mediastinal lymph nodes]

The results of routine roentgenotomography, CT and USI in the diagnosis of intrathoracic metastases of lung cancer were compared in 69 patients (central type--52, peripheral--17). These results were compared with operative findings in 45 patients. The sensitivity of USI in the diagnosis of enlarged paravasal lymph nodes exceeded that of roentgenotomography and was slightly inferior to CT. CT was informative for all mediastinal lymph nodes whereas tomography and USI were informative in certain areas only. The authors recommend to combine the use of routine and ultrasound tomography to assess the spreading of lung cancer to the mediastinum. The information obtained increases the accuracy of staging and specifying a process, slightly yielding CT results.     

Computed tomography symptomatology of liver hemangiomas]

The paper is concerned with analysis of CT-symptomatology of 72 liver hemangiomas in 43 patients. The authors employed standard and dynamic computerized tomography. All hemangiomas were divided into 2 groups: under 6 cm and over 6 cm. Small hemangiomas were characterized by clear-cut contours and regular density. Zones of low density, regular in structure with clear-cut contours were revealed by CT in hemangiomas over 6 cm. Morphologically, this zone corresponded to a hyaline structure (a hyaline slot) making it possible to differentiate hemangiomas from necrotic tumors. In serious cases dynamic CT with visual evaluation and plotting of time-density graphs was recommended. Visually hemangioma had a picture of contrast medium accumulation, beginning from a focal periphery. Graphically the time of appearance of a contrast medium and the time of reaching a maximum for hemangiomas is delayed as compared to the same intervals of contrast medium accumulation in the liver parenchyma. It tells hemangioma graphs from graphs of other tumors, of which intervals coincide with those of liver parenchyma graphs.     

Static and dynamic scintigraphy of the liver using labeled erythrocytes in the diagnosis of hepatic hemangioma]

In order to find hemodynamic differences between hemangioma (n = 10) and other tumours of the liver (n = 15) dynamic angioscintigraphy and late vascular scintigraphy of the liver were performed. Late vascular scintigraphy has revealed focal cumulation of the labelled erythrocytes in 7 hemangiomas of the diameter of 35 mm, 3 hemangiomas below this size have not been diagnosed with this technique. Beside hemangiomas, a focus of erythrocytes cumulation was found also in the hepatocellular adenoma. Arterial blood supply to hemangioma was significantly higher, than that in the malignant tumours of the liver (54.6% vs 31.7%). Other parameters of the early phase of angioscintigraphy have no diagnostic value in the differentiating the hepatic tumours. Vascular scintigraphy of the liver proved to be a valuable technique in the diagnosis of large hemangiomas only.     

Ultrasonography and computed tomography in the detection of overlooked gauze surgical dressings]

USI and CT were performed in 14 patients with textile foreign bodies left in the abdominal cavity and retroperitoneal space during operation on the biliary tracts (6 cases), kidneys (4 cases), pancreas (2), stomach (1), and during appendectomy (1). A decisive sign in USI that enabled one to detect gauze foreign bodies, was a stable echogenic zone corresponding to a proximal body contour with a solid acoustic shadow behind. Extra-organic localization of these changes contributed to making diagnosis. A certain amount of fluid could be seen around a foreign body during an exudative reaction. In CT, diagnosis was based on the detection of a formation with a capsule containing calcinates and air masses.     

Comparison of the diagnostic capacities of imaging methods for childhood hemangiomas

The diagnostic capacities of three imaging methods: B-mode ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) in orbital hemangiomas in babies were compared. Orbital ultrasound, computed tomography, and MRI scans were examined in 358, 384, and 48 babies, respectively. Their mean age was 6.7 months. Out of three techniques, ultrasound scanning proved to be of less informative value. MRI and CT were much more informative although each of them had advantages and limitations. The authors give some preference to CT despite its ionization.     

Echotomography in the diagnosis of pleural effusion]

USI of the pleural cavities was performed in 119 patients (65 men and 54 women) aged 30 to 90 with different abnormalities. Pleural fluid in 106 patients was the leading symptom of the main pathological process, in 13 patients it was a sign of pleural disease. USI was combined with routine x-ray methods. Minimum amounts of pleural fluid could be clearly visualized by ultrasound scanning. Echo-tomographic symptoms of free and encapsulated fluid as well as ultrasound signs permitted differentiation of pleural thickening and exudate accumulation. A program of diagnostic algorithm was worked out for pleural fluid.     

Computed tomography in the differential diagnosis of biliary, duodenal and pancreatic diseases]

The paper is concerned with analysis of CT-investigation of 150 patients with diseases of the bilio-pancreatoduodenal area, whose diagnosis was verified histologically or by clinical observation over time, using other methods (USI, RCPG, etc.). The authors have arrived at a conclusion that for increasing the informative value of CT one should use various methods of a contrast study of the duodenum and biliary tract, electron reconstruction of CT images in different projections. They have pointed out the most significant differential-diagnostic CT signs, proposed a table to facilitate the identification of causes and a level of obturation of the bile ducts, the table playing an important role in a choice of adequate therapy.     

Transiently arterialized hemangiomas: relevant clinical and cardiac issues

Although the majority of hemangiomas of infancy undergo an uncomplicated, predictable course of proliferation followed by involution, a subset of patients sustain a more fastidious course. These include hemangiomas that, at least during part of their life cycle, have a high flow (arterial) component. Hemangiomas with high flow are most frequently located in the liver. These lesions can lead to significant morbidity, with high output cardiac failure. We have identified nonhepatic hemangiomas that have an apparent propensity to develop a high flow element--the parotid, upper arm, scalp, and rarely the upper lip--and present our experience in this report. These lesions appear to behave as transiently "arterialized" hemangiomas.     

Ultrasonics in the diagnosis of stomach tumors]

Proceeding from analysis of over 2000 ultrasound investigations (USI) the role of this method in the diagnosis of stomach tumors was defined (employed during routine investigation of the abdominal cavity and as a procedure with liquid filling of the stomach cavity). Ultrasound semiotics of a neoplastic process of the stomach was described. USI can be used for screening and specification. Various methodological approaches were proposed with regard to purposes to be achieved. Routine methods (x-ray and endoscopy) were shown to remain the chief methods. USI can be used in doubtful cases or for obtaining detailed information. The most valuable are its potentialities in showing details of intraparietal changes in endophytic stomach carcinomas which are difficult for diagnosis.     

MR扩散加权成像和CT及MR灌注成像对不同程度肝硬化患者的诊断价值

目的:研究MR扩散加权成像(DWI)和CT及MR灌注成像对不同程度肝硬化患者的诊断价值。方法:选择从2015年8月到2017年2月在我院治疗的肝硬化患者60例作为研究对象,根据Child-Pugh分级进行分组,其中A级32例为轻度肝硬化(记为A组),B级16例、C级12例为中重度肝硬化(记为B组),另选同期在我院进行体检的健康志愿者30例记为C组,对三组受试者分别进行DWI检查、CT及MR灌注成像,对比各组ADC值、肝脏动门脉灌注比率[SSr(ct)及SSr(mr)],采用Spearman相关性分析各指标之间的相关性。结果:三组ADC值整体比较无统计学差异(P0.05),A、B两组的ADC值较C组降低,但差异无统计学意义(P0.05)。A、B两组的ADC值比较无统计学差异(P0.05)。三组SSr(ct)、SSr(mr)整体比较,差异有统计学意义(P0.05),B组的SSr(ct)及SSr(mr)较A、C两组明显升高,差异均有统计学意义(均P0.05)。A、C两组的SSr(ct)及SSr(mr)比较无统计学差异(P0.05)。Spearman相关性分析显示,不同程度肝硬化患者的SSr(ct)与SSr(mr)呈正相关(r=0.687,P=0.000)。结论:CT以及MR灌注成像均可较好地反映出肝硬化的病变程度,且二者较DWI成像的诊断效果更佳,值得临床推广。     

Massive primary hepatic tuberculoma mimicking hepatocellular carcinoma in an immunocompetent host

Tuberculoma of the liver is rare in an immunocompetent individual. We report a 26-year-old man with upper abdominal pain, abnormal liver function, and raised inflammatory markers. Abdominal computed tomography (CT) scan revealed a mixed attenuation lesion measuring 6 x 5 cm occupying most of the left lobe of the liver. Subsequent histology and culture confirmed tuberculous abscess. Following antituberculous therapy, repeat CT scan revealed complete resolution of the initial findings. This case illustrates the diagnostic difficulties of hepatic tuberculosis (TB) and the importance of considering TB in patients with hepatic lesions.     

Comprehensive Comparison of Multiple-Detector Computed Tomography and Dynamic Magnetic Resonance Imaging in the Diagnosis of Hepatocellular Carcinoma with Varying Degrees of Fibrosis

Methods841 patients with liver tumor who had liver CT or dynamic MRI examinations followed by surgical resection were included in the study. We defined typical HCC imaging characteristics as early enhancement in the artery phase and early washout in the venous phase. The tumor size was recorded based on pathological examination after surgery. The pathologic fibrosis score was verified by the METAVIR scoring classification.ResultsAmong the 841 patients, 756 underwent liver CT and 204 underwent dynamic liver MRI before surgery. The etiologies of chronic liver disease included hepatitis B virus, hepatitis C virus, hepatitis B and C virus, and non-hepatitis B or C virus. The sensitivity and accuracy of liver CT or MRI for HCC diagnosis was approximately 80%~90%. Liver CT had a diagnostic accuracy for HCC similar to that of dynamic MRI, and liver fibrosis stage did not influence their diagnostic efficacies.ConclusionsThe application of 4-phase dynamic CT and MRI exhibit similar diagnostic accuracy for hepatocellular carcinoma, in tumors of sizes 1 to 2 cm and >2 cm. Liver fibrosis status did not affect the diagnostic accuracy of liver CT or MRI for HCC. The AASLD and EASL restrictions of dynamic imaging studies for HCC diagnosis to cirrhotic patients alone are unnecessary.     

Ophthalmic issues in hemangiomas of infancy

Hemangiomas are the most common benign tumor of infancy. Although most hemangiomas remain asymptomatic, certain hemangiomas can cause significant morbidity and require treatment. Periocular hemangiomas require close observation and early therapy for those lesions with potential for visual impairment. Hemangiomas typically cause visual morbidity by induction of amblyopia, strabismus, significant refractive error or optic nerve compromise. Diagnosis is typically straightforward but occasionally other entities may cause diagnostic confusion and radiologic evaluation can be helpful. This is particularly important if the hemangioma is one component of the PHACES syndrome. Therapeutic options which may be useful include steroids (oral, intralesional or topical), interferon alpha (usually reserved for life- or sight-threatening lesions due to serious potential side effects), laser, embolization and surgery. Ophthalmic treatment using patching, atropine, glasses and stabismus surgery may be necessary.     

食盐加碘后甲状腺摄131I 率的变化及其与尿碘的关系

目的：了解食盐加碘后健康人及甲亢患者甲状腺摄131I 率的变化及其与24 小时尿碘含量的相关性,探讨甲状腺摄131I 率与 碘营养状况的关系。方法：对比食盐加碘前后健康体检者及甲亢患者甲状腺摄131I 率的变化,分析健康体检者甲状腺摄131I 率、晨 尿碘浓度及经肌酐校正的尿碘含量与24小时尿碘含量的相关关系。结果：健康人及甲亢患者食盐加碘后3、6 及24 小时甲状腺 摄131I 率均显著降低;健康体检者甲状腺摄131I 率与24 小时尿碘含量呈负相关（r=－0.7651, P<0.001）,晨尿碘浓度与24 小时尿碘 含量呈正相关（r=0.8231, P<0.001）,经肌酐校正的尿碘含量与24 小时尿碘含量呈正相关（r=0.9054, P<0.001）。结论：食盐加碘对甲 状腺摄131I 率有显著影响,应重新确立甲状腺摄131I 率的正常范围及甲亢的诊断标准;经肌酐校正的尿碘含量较晨尿碘浓度能更 准确地反映碘营养状况;甲状腺摄131I率可作为评估个体碘营养状况的指标,可以稳定地反映近期的碘营养状况。     

Invasive interventions guided by computerized tomography in the diagnosis and treatment of diseases of the internal organs

Diagnostic punctures under CT guidance were made in 544 patients with diseases of the chest (n = 303), abdomen (n = 149), and retroperitoneal space (n = 92). In 87 patients, diagnostic punctures were combined with therapeutical manipulations and included aspiration and drainage of visceral organ cysts and abscesses. The proposed procedure of diagnostic biopsies under CT guidance could ascertain the morphological nature of a lesion in 90.1% of cases prior to treatment. Therapeutical aspirations and drainage of visceral cysts and abscesses under CT guidance resulted in their complete recovery in 97.8 and 85.7% of cases, respectively. Diagnostic and therapeutical interventions under CT guidance caused complications in 6.9% of cases. At diagnostic biopsy, pneumothorax is the most frequent complication *5.3%), and lung tissue hemorrhage along the puncture needle passage is the less frequent (1.3%). The use of therapeutical interventions developed complications in 1.1% of cases.     

MRI和螺旋CT增强在肝脏占位性病变诊断中的价值比较

目的:对比分析MRI和螺旋CT增强在肝脏占位性病变诊断中的价值。方法:以2012年7月-2016年5月我院收治的临床考虑为肝脏占位性病变70例患者为研究对象,将70例患者根据入组先后顺序分为两组,35例行增强CT扫描,35例行动态增强MRI扫描,比较两组患者的病理诊断结果、病灶个数及直径、增强CT及MRI的诊断结果和检查过程中的不良反应及耐受性。结果:CT增强组和MRI增强组的肝脏占位性病变的病理诊断、病变类型、分布及病灶个数(71 vs 70)、病灶直径(2.25±2.01 cm vs2.19±1.98 cm)比较差异均无统计学意义(P0.05);以病理诊断结果为金标准,MRI增强组的总诊断符合率为85.71%,CT增强组的总诊断符合率为77.14%,MRI增强组的总诊断符合率高于CT增强组,但差异无统计学意义(P0.05);CT增强组共发生2例不良反应,均为轻度恶心,MRI增强组未出现造影剂不良反应,CT增强组的不良反应发生率(5.71%vs 0.00%)及视觉模拟评分法(VAS)评分(1.25 0.96分vs 0.71 0.56分)均显著高于MRI增强组(P0.05)。结论:CT增强和MRI增强扫描对于肝脏占位性病变的诊断均具有较高的临床价值,其中MRI增强扫描的安全性和耐受性更高,临床医师可根据患者的经济状态、身体状态等因素的综合评估,选择合适的检查手段,必要时可两者联合检查,以提高诊断的准确性。     

Feasibility of 4D CT simulation with synchronized intravenous contrast injection in hepatocellular carcinoma

BackgroundDelivering Stereotactic Body Radiotherapy (SBRT) for Hepatocellular Carcinoma (HCC) is challenging mainly for two reasons: first, motion of the liver occurs in six degrees of freedom and, second, delineation of the tumor is difficult owing to a similar density of HCC to that of the adjoining healthy liver tissue in a non-contrast CT scan. To overcome both these challenges simultaneously, we performed a feasibility study to synchronize intravenous contrast to obtain an arterial and a delayed phase 4D CT.Materials and MethodsWe included seven HCC patients of planned for SBRT. 4D CT simulation was performed with synchronized intravenous contrast based on the formula T_{SCAN DELAY} = T_peak – (L₀/Detector Coverage × Cine Duration in Seconds). This was followed by a delayed 4D CT scan.ResultsWe found that, with our protocol, it is feasible to obtain a 4DCT with an arterial and a delayed phase making it comparable to a diagnostic multi-phase CT. The peak HU of the 4D scan and diagnostic CT were similar (mean peak HU 134.2 vs 143.1, p value = 0.58 N.S). Whereas in comparison with a non-contrast CT a significant rise in the peak HU was seen (mean peak 134.2 vs 61.4 p value = .00003).ConclusionA synchronized contrast 4D CT simulation for HCC is safe and feasible. It results in good contrast enhancement comparable to a diagnostic 3D contrast CT scan.     

Interaction between fast and ultra-slow inactivation in the voltage-gated sodium channel. Does the inactivation gate stabilize the channel structure?

Recently, we reported that mutation A1529D in the domain (D) IV P-loop of the rat skeletal muscle Na(+) channel mu(1) (DIV-A1529D) enhanced entry to an inactivated state from which the channels recovered with an abnormally slow time constant on the order of approximately 100 s. Transition to this "ultra-slow" inactivated state (USI) was substantially reduced by binding to the outer pore of a mutant mu-conotoxin GIIIA. This indicated that USI reflected a structural rearrangement of the outer channel vestibule and that binding to the pore of a peptide could stabilize the pore structure (Hilber, K., Sandtner, W., Kudlacek, O., Glaaser, I. W., Weisz, E., Kyle, J. W., French, R. J., Fozzard, H. A., Dudley, S. C., and Todt, H. (2001) J. Biol. Chem. 276, 27831-27839). Here, we tested the hypothesis that occlusion of the inner vestibule of the Na(+) channel by the fast inactivation gate inhibits ultra-slow inactivation. Stabilization of the fast inactivated state (FI) by coexpression of the rat brain beta(1) subunit in Xenopus oocytes significantly prolonged the time course of entry to the USI. A reduction in USI was also observed when the FI was stabilized in the absence of the beta(1) subunit, suggesting a causal relation between the occurrence of the FI and inhibition of USI. This finding was further confirmed in experiments where the FI was destabilized by introducing the mutations I1303Q/F1304Q/M1305Q. In DIV-A1529D + I1303Q/F1304Q/M1305Q channels, occurrence of USI was enhanced at strongly depolarized potentials and could not be prevented by coexpression of the beta(1) subunit. These results strongly suggest that FI inhibits USI in DIV-A1529D channels. Binding to the inner pore of the fast inactivation gate may stabilize the channel structure and thereby prevent USI. Some of the data have been published previously in abstract form (Hilber, K., Sandtner, W., Kudlacek, O., Singer, E., and Todt, H. (2002) Soc. Neurosci. Abstr. 27, program number 46.12).