The Utility of Three-Dimensional of the T1-Weighted MR Cholangiography with Gd-EOB-DTPA for the Evaluation of a Common Bile Duct Obstruction

PURPOSE: To prospectively assess the utility of the three-dimensional T1 weighted magnetic resonance cholangiography (MRC) with Gd-EOB-DTPA (Primovist(R)) in patients suspected of having a mild common bile duct obstruction. MATERIALS AND METHODS: A total of 30 patients suspected of having a mild common bile duct obstruction were enrolled in this study. A T2 weighted MRC and a three-dimensional T1 weighted MRC with Gd-EOB-DTPA (Primovist(R)) were performed. Within 48 h of the MRC, we performed direct cholangiographies by way of an endoscopic retrograde cholangiography and a surgical cholangiography. Reviews of the data by two experienced radiologists were in consensus. RESULTS: Within 40-60 min of the injection of contrast fluid, the contrast showed the maximum intensity within a common bile duct in 26 of the 30 patients (87%). However, the contrast was poorly visible for as long as 2 hours after injection in 4 of the 30 patients (13%). The sensitivity, specificity, as well as the positive and negative predictive values of the three-dimensional T1 weighted MR cholangiography were 92%, 40%, 88%, and 50%, respectively. CONCLUSION: The three-dimensional, T1 weighted MRC with Gd-EOB-DTPA (Primovist(R)) may be a useful ancillary diagnostic modality for evaluating a patient with mild common bile duct obstruction.

The Relationship between Juxtapapillary Duodenal Diverticula and Biliary Diseases: An Evaluation by the Use of MDCT Multiplanar Reformation

PURPOSE: This study was designed to assess the CT findings of a juxtapapillary duodenal diverticulum (JPDD) and to determine if there is an association between a JPDD and biliary disease using MDCT multiplanar reformation (MPR). In addition, a study was performed to determine if MPR is more useful than an axial image only for an analysis of duodenal diverticula. MATERIALS AND METHODS: A total of 49 patients who had JPDD as identified on an MDCT image were retrospectively included in this study. Patients were divided into two groups: patients with biliary disease (Group 1) and patents without biliary disease (Group 2). A total of 23 patients (46.9%) had biliary disease. We analyzed the size, location, content of the diverticulum, compression of the biliary duct by a diverticulum and the site of a duodenal papilla with an axial image only and MPR images. RESULTS: The frequency of biliary disease was increased when the papilla was located inside a diverticulum (p = 0.033). The use of an MPR image was more useful than an axial image alone for the evaluation of a site of a duodenal papilla. CONCLUSION: A JPDD is associated with the development of biliary disease and the risk of biliary disease is increased when the papilla is located in a diverticulum. An MPR image can provide more precise information about the site of a papilla than an axial image for the evaluation of a JPDD.

Splenic Arteriovenous Malformation Manifestated by Thrombocytopenia in Hereditary Hemorrhagic Telangiectasia: A Case Report

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant inherited disease characterized by epistaxis, telangiectases and visceral arteriovenous malformations (AVMs). The involvement of the gastrointestinal tract, liver, lung and cerebrum for HHT has been described, whereas little is known about AVMs of the spleen. We report here the radiological findings of a case of a splenic AVM manifested by thrombocytopenia in HHT.

Hepatocellular Carcinoma with Neuroendocrine Differentiation: Clinical and Imaging Findings in Five Patients

PURPOSE: To describe the clinical and imaging findings of hepatocellular carcinoma with neuroendocrine differentiation, which is an extremely rare variant of hepatocellular carcinoma. MATERIALS AND METHODS: We collected five patients who had histopathologically proven hepatocellular carcinoma with neuroendocrine differentiation, and described morphologic feature, enhancement pattern of tumors, extrahepatic manifestation and clinical findings. RESULTS: At CT, the tumor size ranged from 8 to 17 cm (mean : 12 cm) in maximum diameter. The tumor margin was well-defined and smooth in four patients and all tumors were heterogeneously hypoattenuating. Four tumor showed rim enhancement on arterial and portal phases. Local invasion to the portal vein, intrahepatic duct and gallbladder were seen. Extrahepatic manifestations included hepatic metastases, lymph node metastasis. At ultrasonography, the tumor showed heterogeneously hyperechoic in all patients and hypoechoic rim was found in four patients. Of four patients who were followed up, one survived for 16 months after initial diagnosis, while the other three died within 3 months after initial diagnosis. CONCLUSION: As described above, clinical and imaging findings of hepatocellular carcinoma with neuroendocrine differentiation were not specific. However, this rare variant of hepatocellular carcinoma could be considered when hepatic tumor is found in an advanced stage and shows persistent rim enhancement at CT.

Morphological Variation of the Kidney Secondary to Junctional Parenchyma on Ultrasound

PURPOSE: To evaluate the prevalance of morphological variation of the kidney secondary to junctional parenchyma, as well as to analyze the ultrasonographic features of junctional parenchyma. MATERIALS AND METHODS: Two hundred and eighty two kidneys of 141 patient without clinical or radiologic evidence of renal disease were prospectively analysed using ultrasound. In all patients, ultrasonograms were obtained in sagittal, coronal and transaxial planes. The kidney was considered to have morphological variation if the ulrasonogram demonstrated junctional parenchymal defect or line ; those showing such variation were classified as one of three types :continuous, discontinuous, or junctional parenchymal line or defect without junctional parenchyma. The prevalance and ultrasonographic features of the kidneys were evaluated. RESULTS: Morphological variation was noted in 71 cases(25%). the continuous type accounted for 54% of these, the discontinuous type for 38%, and junctional parenchymal defect or line without junctional parenchyma for 8%. In all cases, junctional parenchyma was located approximately at the junction of the upper and middle third of the kidny, and had the same echogenecity as the renal cortex. CONCLUSION: An understanding of the morphological variation of the kidney resulting from junctional renal parenchyma would be helpful in differentiating pseudo tumor from true renal neoplasm.

Peripheral Arterial Thrombolysis by Modified Pulse-Spray Method

PURPOSE: The purposes of this study were to evaluate the efficacy of thrombolysis and to find optimal dose of urokinase and injection time by modified pulse-spray method with multiside-hole catheter in patients of arterriosclerosis obliterans of lower limbs. MATERIALS AND METHODS: Over a 2 month period, 5 cases of peripheral arterial occlusion of lower limbs were treated with 0.7--1.3 million unit of urokinase by modified pulse spray method. With antegrade puncture at the site of superficial femoral artery, the tip of modified pig tail catheter was initially placed approximately 2cm proximal to the distal end of the clot. The procedure started with the use of initial bolus dose of UK(100,000U) of lacing, and then small pulses of highly concentrated urokinase, which are forcefully sprayed throughout the thrombus at a rate of 20,000U/min. After the initial rapid period of deposition, the concentration of UK was reduced to 4,000U/min for residual thrombus. RESULTS: Complete clot lysis were achieved in 3 of 5 occlusions. Mean duration for completion of lysis was 140 min(40-180min) and initial recanalization of artery required 45min(20-90min). Total required dose of UK was 1,120,000U and mean dose for initial recanalization was 660,000U. No significant complications occurred except distal vasospasm in one case. CONCLUSION: Modified pulse spray method using ultrahigh and high dose urokinase is safe, reguires less time and has cost effectiveness in the management of peripheral arterial thrombolysis. Further study is warranted.