An Experimental Study on the Effect of Mixture of Absolute Ethanol and Lipiodol Injected into Normal Liver ofRabbit: CT Features and Histopathologic Changes

PURPOSE: To investigate the safety and usefulness of Lipiodol-percutaneous transhepatic ethanolinjection(L-PEI) and to determine the appropriate concentration of Lipiodol during L-PEI. This was achieved byevalvating CT findings and histopathologic changes according to the concentration of Lipiodol, amount of ethanol,and the time interval after injection into normal rabbit liver. MATERIALS AND METHODS: This experimental studyinvolved 18 New Zealand rabbits under US guidance. They were divided into five groups according to injectedmaterials; two rabbits with 0.4cc of normal saline(group I), six with 0.4cc of ethanol in the left hepaticlobe(group II), and 0.4cc of Lipiodol in the right hepatic lobe(group III), five rabbits with 5%Lipiodol-ethanol(5% vol. of Lipiodol+95% vol. of ethanol), 0.2cc in the right hepatic lobe, and 0.4cc in theleft(group IV); and five rabbits with 10% Lipiodol-ethanol as per group IV(group V). CT was performed immediately,one week, two weeks, and three-four weeks after injection, and pathologic specimens were obtained on the thirdday(acute phase) and during the third or fourth week(chronic phase) after injection. RESULTS: On CT, intrahepaticlocalization of the L-PEI injection site was well demonstrated as a focal high attenuated area which graduallydecreased in attenuation on follow up CT. The opacification of the inferior vena cava by Lipiodol, the lineardistribution of Lipiodol along portal veins or fissures, and peritoneal leakage were clearly demonstrated ingroups III-V, though the effects gradually disappeared during follow-up CT. There was no remarkable difference ingross CT attenuation between group IV and group V. The main pathologic findings during the acute phase of group IIwere coagulation necrosis surrounded by macrophage, inflammatory reaction, and early periportal and subcapsularfibrosis. The findings in group IV and V were similar to those in group II and additional fat vacuoleaccumulations in the necrotic area were also seen. During the chronic phase of group II, areas of necrosis wereabsent or smaller and were surrounded or replaced by more organized fibrosis, macrophage or multinucleated giantcell infiltration. Periportal, subcapsular fibrosis was also found. In group IV and V, the findings were similarto those of group II, though additional fat vacuoles in fibrotic or necrotic areas, foreign body reaction to fatvacuole, regenerating nodule and calcification were also observed. CONCLUSION: L-PEI is more useful for thedetection by CT of an injection site than PEI alone, and with regard to CT and histopathologic findings, there wasno significant difference between the 5% and 10% Lipiodol-ethanol groups. Compared to PEI, L-PEI provoked nosighificant additional hepatic injury; only fatty change and foreign body reaction were noted. Thus, L-PEI is moreuseful than PEI for the management of HCC.

Pseudolesion in Segment IV of the Liver on CT Arterial Portography

PURPOSE: To determine the incidence of pseudolesions seen in the posterior aspect of segment IV of the liveron CT arterial portography(CTAP), and to evaluate the findings of CT hepatic arteriorgraphy(CTHA) and celiacangiography. MATERIALS AND METHODS: We retrospectively analysed 450 cases of patients who had undergone CTHA,CTAP and celiac arteriorgraphy for the diagnosis and treatment of hepatic lesion, and evaluated the incidence andimaging findings of pseudolesions in segment IV of the liver, as seen on CTAP, CTHA and celiac arteriography. RESULT: In 28 of 450 patients(6.2%), pseudolesions of focal perfusion defect were seen in segment IV on CTarterial portography. Pseudolesions were seen on CTAP on 39 different section slices ; these were wedge-shaped in41% of cases(16/39), rectangular in 30.8%(12/39), ovoid-shaped in 23.1%(9/39), and half moon-shaped in 5.1%(2/39); they were from 1 to 3cm(average, 1.5cm) in anteroposterior diameter, from 1 to 3cm(average, 1.9cm) in width, andfrom 1 to 4cm(average, 1.9cm) in craniocaudal diameter. Twenty-seven patients underwent CTHAs ; hyperattenuationwas seen in 13(48.2%), isoattenuation in 12(44.4%), and hypoattenuation in two(7.4%). In 19 of 28 celiacangiograms(67.9%), the right gastric artery was seen to arise from the hepatic artery, and aberrant right gastricveins directly draining into the left lobe of the liver were seen in three(10.7%). CONCLUSION: The incidence ofpseudolesion seen in segment IV of the liver on CTAP was 6.2% (28/450), and in 3 of 28 cases(10.7%), celiacangiography showed aberrant right gastric venous drainage. For pseudolesions, CTHA showed variable attenuation,and this modality is less sensitive than CTAP for the detection of pseudolesion.

Hemodynamic Change by Portal Tumor Thrombus in Hepatocellular Carcinoma: Evaluation by Combined Spiral CT Hepatic Arteriography and CT Arterial Portography

PURPOSE: To evaluate the hemodynamic change by portal tumor thrombus in hepatocellular carcinoma(HCC). MATERIALS AND METHODS: We reviewed 35 cases of combined spiral CTHA and CTAP in 25 HCC patients with portal tumorthrombus from April 1993 to October 1994, regarding to portal tumor thrombus, the involved area of arterioportal(AP) shunt and the development of cavernous transformation of portal vein, in comparison with hepaticand superior mesenteric arteriography. RESULTS: Spiral CTHA showed hyperattenuating tumor, portal tumor thrombus and hyperattenuating peritumoral parenchymal area. Spiral CTAP showed perfusion defect area including tumor, portal tumor thrombus and peritumoral area distal to portal vein obstruction. In 15 cases, portal tumor thrombus showed intraluminal and marginal hyperattenuating linear structures on CTHA due to transvasal AP shunt and tumor feeding arteries, which were corresponding to thread and streaks sign on hepatic arteriography. Cavernous transformation of portal vein was demonstrated in 15 cases as irregular periportal hyperattenuating collateral vessels on spiral CTAP. In 32 cases, portal vein was visualized on CTHA due to AP shunt. And according to shunt amount, we classified AP shunt into 4 grades. Grade I means only the presence of portal tumor thrombus without AP shunt, grade II with segmental AP shunt, grade III with one lobar AP shunt, and grade IV with both lobar AP shuntor the presence of cavernous transformation of portal vein. Grade I was seen in 3, grade II in 4, grade III in 13 and grade IV in 15 cases. CONCLUSION: Variable CTHA and CTAP findings were shown in HCC patients with portal tumor thrombus according to the amount of AP shunt and the presence of cavernous transformation of portal vein. Combined CTHA and CTAP are useful to differentiate the tumor thrombus from simple thrombus and are very sensitive method for detecting AP shunt. Understanding these findings related with portal tumor thrombus is important topredict patient}s prognosis and to decide treatment method.

Serial femoral arteriography in Buerger's disease

Femoral arteriography has assumed in recent years a greater clinical and surgical significance, especiallysince the advent of arterial grafting for occlusive arterial disease. Evaluation of the site and extent ofocclusion, the state of distal arterial tree and degree of collateral circulation can best be obtained byserialographic studies. Authors analyzed 28 cases of clinically and radiologically diagnosed Buerger's disease inGURO hospital radiology, College of medicine, Korea university, during last 6 months from March to August, 1984.The results are as follows; 1. The age distribution were between 20 and 50 years old, and most commonly involvedage group was 20-29. 2. The most frequent finding was the obstruction of peripheral artery with or withougcollateral vessel and almost all patient had occlusion more than 1 segmental branch. 3. The most frequentlyinvolved arteries in Buerger's disease were trifurcation area below the knee joint, anterior and posterior tibialartery and peroneal artery. Peroneal artery was less commonly involved than anterior or posterior tibial artery.

Clinical evaluation of praziquantel(Embay 8440; Biltricide) in the treatment of Paragonimus westermani

A total of 52 paragonimiasis patients was treated with praziquantel at three dose levels: 21 patients received 3 x 25.0 mg/kg bwt on a single day, 21 patients were treated with 3 x 25.0 mg/kg for 2 consecutive days and 10 patients were treated with the same dose for 3 consecutive days. Follow-up examination were carried out at monthly up to 4 months (120 days) after treatment. Fifteen (71.4%) out of 21 patients who received the drug 3 x 25.0 mg/kg bwt on a single day were parasitologically cured. Eighteen (85.7%) out of 21 patients who received 3 x 25.0 mg/kg bwt for 2 consecutive days were also cured. Six and 3 of uncured cases in each above groups were treated again with doses of 3 x 25.0 mg/kg bwt for 2 or 3 consecutive days. Two (consisting each one in each group ) of nine retreated cases were failed in parasitological cure. Therefore the overall cure rates of 95.2 % (20 out of 21 cases) in each group were finally obtained. On the other hand, in 10 patients who received 3 x 25.0 mg/kg bwt for 3 consecutive days, complete cure was obtained at 4 months follow-up examinations. Praziquantel is well tolerated and side effects consist particularly of mild and transient headache and dizziness. There was no great difference between the three dosage groups. Extended hematological and biochemical tests, and urinalysis, revealed no abnormal findings which could be related to the compound after therapy. The disappearance of precipitating bands of immunoelectrophoresis together with the disappearance of abnormal shawdows in chest X-ray after treatment gave a potent proof on assuring the cure of paragonimiasis.