Enhancement Pattern of Hepatocellular Carcinoma on Triphasic Helical CT: Quantitative Study

PURPOSE: To assess the enhancement pattern of hepatocellular carcinoma (HCC), as seen on triphasic helical dynamic computed tomography (CT) by measuring the attenuation value. MATERIALS AND METHODS: Triphasic helical dynamic CT scans of the liver in 94 patients (M:F=73:21; aged 33-81 years) with HCC were evaluated. The condition was confirmed on the basis of histologic (n=28) or clinical (n=66) findings. Scans were obtained at 30, 70, and 180 seconds after the start of contrast material injection, the attenuation values of the solid portion of the HCC and adjacent normal liver parenchyma being measured during the three phases. Enhancement patterns of the HCC nodule and adjacent liver parenchyma were analyzed, and the size of HCCs, the presence or absence of portal vein thrombosis, and the Child classification were also determined. RESULTS: The mean attenuation values of HCC were 69 HU during the arterial phase, 80 HU during the portal phase, and 65 HU during the delayed phase, while those of liver parenchyma were 48 HU, 81 HU and 72 HU, respectively. In 71.3% of cases (67/94), maximum enhancement occurred during the portal phase. Decreased tumor attenuation after peak enhancement was seen in 71.3% of lesions (67/94, Group I). while in 28.7% (27/94, Group II) attenuation showed no significant decrease. There were no statistically significant differences in the size of HCCs, portal vein thrombosis or Child classification between the two groups (p>0.05). CONCLUSION: On triphasic helical dynamic CT, the mean attenuation value of HCCs was highest during the portal phase. Over time, the majority of HCCs showed a decreased attenuation value.

Meniscal Abnormalities in Soccer Players: Prevalence and MR Imaging

PURPOSE: We aimed to know the prevalence of abnormal meniscal signal on MR imaging in asymptomatic soccer players and its radiologic significance. MATERIALS AND METHODS: Using T1 and gradient echo T2* weighted sagittal and coronal MR image, 48 knees in twenty-four full time soccer players were evaluated for the meniscal abnormalities, the status of ligament and existance of joint effusion. Meniscal abnormalities were interpretated using grading system of Lotysch. By using Chi-square method, We analyzed the existance of joint effusion could divide the healing state and healed state of the meniscus. RESULTS: The prevalence of Grade 2 and more and Grade 3 were 42% and 39% of asymptomatic knees. In the 24 knees with meniscus tear, nine of the 14 asymptomatic knee showed effusion while eight of the 10 symptomatic knee did. Of 24 knees with meniscal tear, only eleven knees were related to previous history of major knee trauma. CONCLUSIONS: The prevalence of meniscal abnormalities on MR imaging in asymptomatic soccer players was higher(grade 3:39%) than we expected. The joint effusion was not helpful to divide the healing state and healed state of the meniscus. So we suggest baseline MR imaging in the athletes who have been using the knee vigorously could give decisive information for the interpretation of subsequent MRI that may be performed when the players wounded.

Chronic Recurrent Hemoptysis: Effectiveness of Bronchial Artery Embolization in 25 Patients

PURPOSE: Bronchial artery embolization has been effective in the treatment of massive hemoptysis. The purpose of this study was to report the effectiveness of bronchial artery embolization in patients with chronic recurrent hemoptysis intractable to medical treatment. MATERIALS AND METHODS: This study included 25 patients who were admitted for treatment of chronic recurrent hemoptysis with bronchial artery embolization. Chronic recurrent hemoptysis was defined as condition intractable to medical treatment persistently and occuring over two times per two months. The target vessels for embolization were selected in consideration of the results of aortography as well as the finding of chest radiography and bronchoscopy. After selective arteriography for embolization by using 5-French Simmons catheter, embolic agents(mainly polyvinyl alcohol(PVA) and additionally gelfoam and coils) were released through the catheter. The results of the embolization were assessed with the review of medical records. RESULT: The causes of the hemoptysis were pulmonary tuberculosis(n=12,48%), bronchiectasis(n=6,24%), aspergilloma(n=3,12%), chronic obstructive pulmonary disease(n=2,8%), chronic bronchitis(n=I,4%) and lung abscess(n=1,4%). Selective embolization was carried out in 49 sites(42 in bronchial artery and 7 in nonbronchial systemic collaterals). Early success rate within 2 months was 96%. After long-term follow up study (6-30 months, average 15 months), complete remission was 72%, partial remission 12% and recurrence 12% respectively. During and after embolization, major complications such as spinal cord injury or bronchial wall necrosis was not found. Minor complications were chest pain, shoulder pain and chilling sense, which were relieved spontaneously within a few days. CONCLUSION: High success rate and relatively low recurrence with no significant complication were achieved with bronchial artery embolization in the patients complaining of chronic recurrent hemoptysis.

Effect of Transcatheter Arterial Embolization according to Angiographic Findings in Hepatocellular Carcinoma

PURPOSE: The purpose of this study is to assess the effect of Transcatheter Arterial Embolization(TAE) according to anglographic findings in hepatocellular carcinoma. MATERIALS AND METHOD: We retrospectively reviewed 50 cases who received TAE for unresectable hepatocellular carcinoma. We analyzed the anglographic findings which were correlated with the effect of TAE. The common anglographic findings of the hepatocellular carcinoma were tumor staining, neovascularity and enlargement of feeding artery. These anglographic findings were classified into grade 0, +1, +2. Effect of TAE were classified into five patterns;good response, partial response, minimal response, no response and more aggravation. RESULT:In grading of tumor staining, among 50 cases, the grade 0, +1, +2 were seen in 1 case(2%), 14 cases(28%), 35 cases(70%) each. In grading of enlargement of feeding artery, the grade 0, +1, +2 were seen in 7 cases(14%), 19 cases(38%), 24 cases(48%) each. In grading of neovascularity, the grade 0, +1, +2 were seen in 6 cases(12%), 15 cases(30%), 29 cases(58%) each. This study showed that the higher grade of anglographic finding, the better effect of TAE. A statistically significant differance was found (p<0.005). But the TAE was not effective in some cases (the maximum diameter of mass is over 10cm, portal vein thrombosis or ateriovenous shunt) in spite of high grade. CONCLUSION: We believe that these angiogr. aphic findings (tumor staining, enlargement of feeding artery, neovascularity) are one of important indices for anticipating the effect of TAE in patients with unresectable hepatocellular carcinoma.