Total Bilirubin Level as a Predictor of Suboptimal Image Quality of the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI in Patients with Extrahepatic Bile Duct Cancer

Objective@#This study aimed to determine a factor for predicting suboptimal image quality of the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI in patients with extrahepatic bile duct (EHD) cancer before MRI examination. @*Materials and Methods@#We retrospectively evaluated 259 patients (mean age ± standard deviation: 68.0 ± 8.3 years; 162 male and 97 female) with EHD cancer who underwent gadoxetic acid-enhanced MRI between 2011 and 2017. Patients were divided into a primary analysis set (n = 184) and a validation set (n = 75) based on the diagnosis date of January 2014. Two reviewers assigned the functional liver imaging score (FLIS) to reflect the HBP image quality. The FLIS consists of the sum of three HBP features, each scored on a 0–2 scale: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified into low-FLIS (0–3) or high-FLIS (4–6) groups. Multivariable analysis was performed to determine a predictor of low FLIS using serum biochemical and imaging parameters of cholestasis severity. The optimal cutoff value for predicting low FLIS was obtained using receiver operating characteristic analysis, and validation was performed. @*Results@#Of the 259 patients, 140 (54.0%) and 119 (46.0%) were classified into the low-FLIS and high-FLIS groups, respectively. In the primary analysis set, total bilirubin was an independent factor associated with low FLIS (adjusted odds ratio per 1-mg/dL increase, 1.62; 95% confidence interval [CI], 1.32–1.98). The optimal cutoff value of total bilirubin for predicting low FLIS was 2.1 mg/dL with a sensitivity of 95.1% (95% CI: 88.9–98.4) and a specificity of 89.0% (95% CI: 80.2–94.9). In the validation set, the total bilirubin cutoff showed a sensitivity of 92.1% (95% CI: 78.6–98.3) and a specificity of 83.8% (95% CI: 68.0–93.8). @*Conclusion@#Serum total bilirubin before acquisition of gadoxetic acid-enhanced MRI may help predict suboptimal HBP image quality in patients with EHD cancer.

Prognosis after Curative Resection of Single Hepatocellular Carcinoma with A Focus on LI-RADS Targetoid Appearance on Preoperative Gadoxetic Acid-Enhanced MRI

Objective@#To evaluate the prognostic implications of preoperative magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) with a focus on those with targetoid appearance based on the Liver Imaging Reporting and Data System (LI-RADS), as well as known microvascular invasion (MVI) features. @*Materials and Methods@#This retrospective study included 242 patients (190 male; mean age, 57.1 years) who underwent surgical resection of a single HCC (≤ 5 cm) as well as preoperative gadoxetic acid-enhanced MRI between January 2012 and March 2015. LI-RADS category was assigned, and the LR-M category was further classified into two groups according to rim arterial-phase hyperenhancement (APHE). The imaging features associated with MVI were also assessed. The overall survival (OS), recurrence-free survival (RFS), and their associated factors were evaluated. @*Results@#Among the 242 HCCs, 190 (78.5%), 25 (10.3%), and 27 (11.2%) were classified as LR-4/5, LR-M with rim APHE, and LR-M without rim APHE, respectively. LR-M with rim APHE (vs. LR-4/5; hazard ratio [HR] for OS, 5.48 [p = 0.002]; HR for RFS, 2.09 [p = 0.042]) and tumor size (per cm increase; HR for OS, 6.04 [p = 0.009]; HR for RFS, 1.77 [p = 0.014]) but not MVI imaging features (p > 0.05) were independent factors associated with OS and RFS. Compared to the 5-year OS and RFS rates in the LR-4/5 group (93.9% and 66.8%, respectively), the LR-M with rim APHE group had significantly lower rates (68.0% and 45.8%, respectively, both p 0.05). @*Conclusion@#Further classification of LR-M according to the presence of rim APHE may help predict the postoperative prognosis of patients with a single HCC.

A Comparative Study of Survivor Outcomes between Preoperative Evaluation Using CT Alone and Combined CT and MRI in Patients with Pancreatic Ductal Adenocarcinoma

Purpose@#To compare the recurrence pattern, disease-free survival (DFS), and overall survival (OS) after curative surgery for pancreatic ductal adenocarcinoma (PDAC) in patients who underwent preoperative evaluation with CT alone or in combination with MRI, and to compare the prognosis according to the first recurrence site. @*Materials and Methods@#We retrospectively evaluated 152 patients who underwent R0 resection of PDAC. Preoperative CT or combined CT and MRI were performed for 103 and 49 patients, respectively. Two radiologists recorded the location and date of the first recurrence in consensus. The recurrence pattern, DFS, and OS were compared between the two groups. OS was analyzed according to the first recurrence site. @*Results@#In both groups, liver metastasis was the most common recurrence pattern. DFS (p = 0.247) or OS (p = 0.067) showed no significant difference between the two groups. OS according to the first recurrence site was the lowest for liver metastasis, followed by locoregional recurrence (p < 0.001). @*Conclusion@#There were no significant differences in the recurrence pattern, DFS, or OS between patients evaluated with preoperative CT alone or with CT and MRI after curative resection of PDAC. Liver metastasis was the most common tumor recurrence pattern with the lowest OS.

A Comparative Study of Survivor Outcomes between Preoperative Evaluation Using CT Alone and Combined CT and MRI in Patients with Pancreatic Ductal Adenocarcinoma

Purpose@#To compare the recurrence pattern, disease-free survival (DFS), and overall survival (OS) after curative surgery for pancreatic ductal adenocarcinoma (PDAC) in patients who underwent preoperative evaluation with CT alone or in combination with MRI, and to compare the prognosis according to the first recurrence site. @*Materials and Methods@#We retrospectively evaluated 152 patients who underwent R0 resection of PDAC. Preoperative CT or combined CT and MRI were performed for 103 and 49 patients, respectively. Two radiologists recorded the location and date of the first recurrence in consensus. The recurrence pattern, DFS, and OS were compared between the two groups. OS was analyzed according to the first recurrence site. @*Results@#In both groups, liver metastasis was the most common recurrence pattern. DFS (p = 0.247) or OS (p = 0.067) showed no significant difference between the two groups. OS according to the first recurrence site was the lowest for liver metastasis, followed by locoregional recurrence (p < 0.001). @*Conclusion@#There were no significant differences in the recurrence pattern, DFS, or OS between patients evaluated with preoperative CT alone or with CT and MRI after curative resection of PDAC. Liver metastasis was the most common tumor recurrence pattern with the lowest OS.

Perineal Metastatic Clear Cell Renal Cell Carcinoma: A Case Report

Perineal involvement by metastatic renal cell carcinoma (RCC) is very rare, and there are only few reports on its radiological findings in the literature. Here, we present a case of a 76-year old female who presented with perineal pain caused by metastatic clear cell RCC. We discuss the radiological changes of the tumor before and after targeted therapy.

Factors affecting the ability of abdominal ultrasonography to detect focal pancreatic lesions identified using endoscopic ultrasonography

Purpose@#This study was conducted to determine which factors influence the ability of abdominal ultrasonography (US) to detect focal pancreatic lesions identified using endoscopic ultrasonography (EUS). @*Methods@#In this study, 338 consecutive patients with focal pancreatic lesions (cyst, n=253; adenocarcinoma, n=54; pancreatic neuroendocrine tumor, n=24; solid pseudopapillary neoplasm, n=4; intrapancreatic accessory spleen, n=1; metastasis, n=1; and lymphoma, n=1) detected by EUS who underwent US were enrolled. We reviewed their radiologic reports and assessed the presence or absence of a focal lesion, the multiplicity of the lesions, and their size and location on US. We evaluated how these parameters differed depending on whether the lesion was solid or cystic. Univariate and multivariate logistic regression analysis were performed. @*Results@#The overall detection rate of focal pancreatic lesions by US was 61.5% (208 of 338). Using US, the detection rate of cystic lesions was 58.5% (148 of 253), while that of solid lesions was 70.6% (60 of 85). In the univariate analysis, location in the neck or body, solid characteristics, and a relatively large size (15.50±10.08 mm vs. 23.09±12.93 mm) were associated with a significantly higher detection rate (P<0.001, P=0.047, and P<0.001, respectively). In the multivariate analysis, location in the neck or body (odds ratio [OR], 3.238; 95% confidence interval [CI], 1.926 to 5.443; P<0.001) and size (OR, 1.070; 95% CI, 1.044 to 1.096; P<0.001) were proven to be significant predictors of detectability (P<0.001). @*Conclusion@#US is useful for detecting focal pancreatic lesions, especially when they are located in the neck or body and are relatively large.

Diagnosis and Surveillance of Incidental Pancreatic Cystic Lesions: 2017 Consensus Recommendations of the Korean Society of Abdominal Radiology

The occurrence of incidentally detected pancreatic cystic lesions (PCLs) is continuously increasing. Radiologic examinations including computed tomography and magnetic resonance imaging with magnetic resonance cholangiopancreatography have been widely used as the main diagnostic and surveillance methods for patients with incidental PCLs. Although most incidentally detected PCLs are considered benign, they have the potential to become malignant. Currently, we have several guidelines for the management of incidental PCLs. However, there is still debate over proper management, in terms of accurate diagnosis, optimal follow-up interval, and imaging tools. Because imaging studies play a crucial role in the management of incidental PCLs, the 2017 consensus recommendations of the Korean Society of Abdominal Radiology for the diagnosis and surveillance of incidental PCLs approved 11 out of 16 recommendations. Although several challenges remain in terms of optimization and standardization, these consensus recommendations might serve as useful tools to provide a more standardized approach and to optimize care of patients with incidental PCLs.

A Case Report of Extramedullary Myeloma Mimicking Lymphoma with Extensive Abdominal Involvement

Extramedullary myeloma refers to the presence of myeloma deposits outside the skeletal system and typically indicates a poor prognosis associated with shorter overall survival and progression- free survival. We report a case of extramedullary myeloma with extensive, abdominal multi-organ involvement mimicking lymphoma at initial diagnosis. Bulky retroperitoneal masses with severe diffusion restriction and patency of encased vessels can be MR findings of both myeloma and lymphoma. Radiologic findings such as arterial hyperenhancement, obstructive uropathy, and the lack of associated lymphadenopathy may favor a diagnosis of myeloma over lymphoma.

The Feasibility Study of Contrast-enhanced Ultrasound Using a 3 Dimension Transducer for Tumor Volume Measurement in Rabbit Hepatic VX2 Carcinoma Comparison with 2 Dimension Ultrasound and 3 Dimension Ultrasound without Contrast: Preliminary Results

BACKGROUND/AIMS: To investigate the feasibility of tumor volume measurement using contrastenhanced ultrasound (US) with 3 dimension transducer (3D CEUS) in rabbit hepatic VX2 carcinoma. METHODS: Three different tumor volume measurements, including 2D US using the equation, 4/3(π)(abc), 3D US without contrast, and 3D CEUS were performed in 35 rabbit hepatic VX2 carcinomas. With the tumor volume from computerized tomography (CT) as a reference standard, we compared difference between CT volume and each different US tumor volume. The mean difference and correlation coefficient between each US volume measurement and CT volume were analyzed. RESULTS: Tumor volume measurement using 3D CEUS and 2D US using equation showed no statistical difference compared to CT volume (0.276 cm3, 0.212 cm3, and 0.263 cm3 vs. 0.306 cm3, 0.247 cm3, 0.276 cm3, P>0.05). However, 3D CEUS provided the highest correlation coefficient with CT volume (R=0.835 and 0.720) and the highest intraclass correlation (0.973 and 0.993). 3D CEUS provided a smaller mean difference with CT volume (0.016 cm3 and 0.033 cm3) than 2D US, showing 3D CEUS's accurate measurement of tumor volume. CONCLUSIONS: Due to its highly accurate, reliable, and reproducible measurements of tumor volume, 3D CEUS may be useful for predicting the therapeutic response evaluation after treatment.

Solid pseudopapillary neoplasm of the pancreas with liver metastasis initially misinterpreted as benign haemorrhagic cyst

Solid pseudopapillary neoplasm (SPN) of the pancreas is considered a low-malignant neoplasm witha good prognosis. However, 5% to 15% of patients with SPNs develop metastatic disease, mostcommonly in the liver. Metastatic hepatic malignancies that show pseudocystic features are rare.Here we describe the case of a middle-aged female with a cystic liver metastasis from SPN. To thebest of our knowledge, SPN with a single cystic liver metastasis has not been described, althoughthese tumours frequently undergo haemorrhagic-cystic degeneration. Thus, in these patients themarked cystic change could be misinterpreted as a benign lesion.

The Role of Endoscopic Biliary Drainage without Sphincterotomy in Gallstone Patients with Cholangitis and Suspected Common Bile Duct Stones Not Detected by Cholangiogram or Intraductal Ultrasonography

BACKGROUND/AIMS: Treatment for cholangitis without common bile duct (CBD) stones has not been established in patients with gallstones. We investigated the usefulness of endoscopic biliary drainage (EBD) without endoscopic sphincterotomy (EST) in patients diagnosed with gallstones and cholangitis without CBD stones by endoscopic retrograde cholangiopancreatography (ERCP) and intraductal ultrasonography (IDUS). METHODS: EBD using 5F plastic stents without EST was performed prospectively in patients with gallstones and cholangitis if CBD stones were not diagnosed by ERCP and IDUS. After ERCP, all patients underwent laparoscopic cholecystectomy. The primary outcomes were clinical and technical success. The secondary outcomes were recurrence rate of biliary events and procedure-related adverse events. RESULTS: Among 187 patients with gallstones and cholangitis, 27 patients without CBD stones according to ERCP and IDUS received EBD using 5F plastic stents without EST. The stents were maintained in all patients until laparoscopic cholecystectomy, and recurrence of cholangitis was not observed. After cholecystectomy, the stents were removed spontaneously in 12 patients and endoscopically in 15 patients. Recurrence of CBD stones was not detected during the follow-up period (median, 421 days). CONCLUSIONS: EBD using 5F plastic stents without EST may be safe and effective for the management of cholangitis accompanied by gallstones in patients without CBD stones according to ERCP and IDUS.

Spontaneous Rupture of Multiple Intrahepatic Cholangiocarcinoma in a Pregnant Patient

Spontaneous rupture of intrahepatic cholangiocarcinoma is rare due to its abundant fibrous stroma. We report our experience in a case of spontaneous rupture of intrahepatic cholangiocarcinoma in a pregnant patient. In our case, multiple hepatic masses with intratumoral hemorrhage were noted on post-delivery computed tomography and magnetic resonance imaging and they caused hemoperitoneum. A right hemi-hepatectomy was carried out to control the bleeding and the diagnosis of intrahepatic cholangiocarcinoma with metastasis was performed.

Henoch-Schonlein purpura: ultrasonography of scrotal and penile involvement

Testicular or scrotal involvement has been reported in children with Henoch-Schonlein purpura (HSP), but there are very few reports on penile involvement. We report the initial and follow-up ultrasonographic findings of scrotal and penile involvement of HSP in a 5-year-old boy. On ultrasonography, scrotal soft tissue thickening and epididymal swelling with increased vascularity were noted, and on the penis, a focal mass-like lesion appeared on the dorsal surface of the distal penis, having a hypoechoic mass-like appearance without visible vascular flow on a Doppler study. After 2 days of treatment, follow-up ultrasonography showed normal scrotum and penis with a resolved soft tissue mass-like lesion. Therefore, we think that HSP ultrasonographic findings involving the scrotum and penis might help to diagnose scrotal and penile involvement in a case of HSP and to avoid unnecessary medication and/or surgical procedures.

Radiofrequency ablation of very-early-stage hepatocellular carcinoma inconspicuous on fusion imaging with B-mode US: value of fusion imaging with contrast-enhanced US

BACKGROUND/AIMS: To determine the value of fusion imaging with contrast-enhanced ultrasonography (CEUS) and computed tomography (CT)/magnetic resonance (MR) images for percutaneous radiofrequency ablation (RFA) of very-early-stage hepatocellular carcinomas (HCCs) that are inconspicuous on fusion imaging with B-mode ultrasound (US) and CT/MR images. METHODS: This retrospective study was approved by our institutional review board and the requirement for informed consent was waived. Fusion imaging with CEUS using Sonazoid contrast agent and CT/MR imaging was performed on HCCs (<2 cm) that were inconspicuous on fusion imaging with B-mode US. We evaluated the number of cases that became conspicuous on fusion imaging with CEUS. Percutaneous RFA was performed under the guidance of fusion imaging with CEUS. Technical success and major complication rates were assessed. RESULTS: In total, 30 patients with 30 HCCs (mean, 1.2 cm; range, 0.6-1.7 cm) were included, among which 25 (83.3%) became conspicuous on fusion imaging with CEUS at the time of the planning US and/or RFA procedure. Of those 25 HCCs, RFA was considered feasible for 23 (92.0%), which were thus treated. The technical success and major complication rates were 91.3% (21/23) and 4.3% (1/23), respectively. CONCLUSIONS: Fusion imaging with CEUS and CT/MR imaging is highly effective for percutaneous RFA of very-early-stage HCCs inconspicuous on fusion imaging with B-mode US and CT/MR imaging.

Pseudocirrhosis as a complication after chemotherapy for hepatic metastasis from breast cancer

No abstract available.