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.

Intraindividual Comparison of Hepatocellular Carcinoma Washout between MRIs with Hepatobiliary and Extracellular Contrast Agents

Objective@#To intraindividually compare hepatocellular carcinoma (HCC) washout between MRIs using hepatobiliary agent (HBA) and extracellular agent (ECA). @*Materials and Methods@#This study included 114 prospectively enrolled patients with chronic liver disease (mean age, 55 ± 9 years; 94 men) who underwent both HBA-MRI and ECA-MRI before surgical resection for HCC between November 2016 and May 2019. For 114 HCCs, the lesion-to-liver visual signal intensity ratio (SIR) using a 5-point scale (-2 to +2) was evaluated in each phase. Washout was defined as negative visual SIR with temporal reduction of visual SIR from the arterial phase. Illusional washout (IW) was defined as a visual SIR of 0 with an enhancing capsule. The frequency of washout and MRI sensitivity for HCC using LR-5 or its modifications were compared between HBA-MRI and ECA-MRI. Subgroup analysis was performed according to lesion size ( 0.999). @*Conclusion@#Extracellular phase washout for HCC diagnosis was comparable between MRIs with both contrast agents, except for tumors < 20 mm. Adding IW could improve the sensitivity for HCC on ECA-MRI in tumors < 20 mm.

Intraindividual Comparison of Hepatocellular Carcinoma Washout between MRIs with Hepatobiliary and Extracellular Contrast Agents

Objective@#To intraindividually compare hepatocellular carcinoma (HCC) washout between MRIs using hepatobiliary agent (HBA) and extracellular agent (ECA). @*Materials and Methods@#This study included 114 prospectively enrolled patients with chronic liver disease (mean age, 55 ± 9 years; 94 men) who underwent both HBA-MRI and ECA-MRI before surgical resection for HCC between November 2016 and May 2019. For 114 HCCs, the lesion-to-liver visual signal intensity ratio (SIR) using a 5-point scale (-2 to +2) was evaluated in each phase. Washout was defined as negative visual SIR with temporal reduction of visual SIR from the arterial phase. Illusional washout (IW) was defined as a visual SIR of 0 with an enhancing capsule. The frequency of washout and MRI sensitivity for HCC using LR-5 or its modifications were compared between HBA-MRI and ECA-MRI. Subgroup analysis was performed according to lesion size ( 0.999). @*Conclusion@#Extracellular phase washout for HCC diagnosis was comparable between MRIs with both contrast agents, except for tumors < 20 mm. Adding IW could improve the sensitivity for HCC on ECA-MRI in tumors < 20 mm.

Preoperative Prediction for Early Recurrence Can Be as Accurate as Postoperative Assessment in Single Hepatocellular Carcinoma Patients

OBJECTIVE: To evaluate the performance of predicting early recurrence using preoperative factors only in comparison with using both pre-/postoperative factors.MATERIALS AND METHODS: We retrospectively reviewed 549 patients who had undergone curative resection for single hepatcellular carcinoma (HCC) within Milan criteria. Multivariable analysis was performed to identify pre-/postoperative high-risk factors of early recurrence after hepatic resection for HCC. Two prediction models for early HCC recurrence determined by stepwise variable selection methods based on Akaike information criterion were built, either based on preoperative factors alone or both pre-/postoperative factors. Area under the curve (AUC) for each receiver operating characteristic curve of the two models was calculated, and the two curves were compared for non-inferiority testing. The predictive models of early HCC recurrence were internally validated by bootstrap resampling method.RESULTS: Multivariable analysis on preoperative factors alone identified aspartate aminotransferase/platelet ratio index (OR, 1.632; 95% CI, 1.056–2.522; p = 0.027), tumor size (OR, 1.025; 95% CI, 0.002–1.049; p = 0.031), arterial rim enhancement of the tumor (OR, 2.350; 95% CI, 1.297–4.260; p = 0.005), and presence of nonhypervascular hepatobiliary hypointense nodules (OR, 1.983; 95% CI, 1.049–3.750; p = 0.035) on gadoxetic acid-enhanced magnetic resonance imaging as significant factors. After adding postoperative histopathologic factors, presence of microvascular invasion (OR, 1.868; 95% CI, 1.155–3.022; p = 0.011) became an additional significant factor, while tumor size became insignificant (p = 0.119). Comparison of the AUCs of the two models showed that the prediction model built on preoperative factors alone was not inferior to that including both pre-/postoperative factors {AUC for preoperative factors only, 0.673 (95% confidence interval [CI], 0.623–0.723) vs. AUC after adding postoperative factors, 0.691 (95% CI, 0.639–0.744); p = 0.0013}. Bootstrap resampling method showed that both the models were valid.CONCLUSION: Risk stratification solely based on preoperative imaging and laboratory factors was not inferior to that based on postoperative histopathologic risk factors in predicting early recurrence after curative resection in within Milan criteria single HCC patients.

Identification of Arterial Hyperenhancement in CT and MRI in Patients with Hepatocellular Carcinoma: Value of Unenhanced Images

OBJECTIVE: According to the current guidelines, arterial hyperenhancement for diagnosis of hepatocellular carcinoma (HCC) is determined using the arterial phase only. We investigated the optimal definition of arterial hyperenhancement in patients with HCC using computed tomography (CT) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study. The requirement for informed consent was waived. Between January 2011 and September 2013, 147 consecutive patients with surgically proven HCCs with both pre-operative CT and MRI were included. Identification rates of arterial hyperenhancement on CT and magnetic resonance (MR) images using arterial phase only, dual phase (unenhanced and arterial phases), and also subtraction MR images were assessed qualitatively. RESULTS: The identification rates for arterial hyperenhancement on CT were significantly different between arterial phase and dual phase (72.8% vs. 90.5%; p < 0.001), whereas the rates were similar on MRI (91.8% vs. 93.9%; p = 0.257). The identification rate of arterial hyperenhancement in MRI increased to 98.6% using subtraction MR images. CONCLUSION: Visual comparison of arterial and unenhanced phases could be recommended instead of conventional qualitative arterial phase alone assessment to determine arterial hyperenhancement of HCCs, especially when using CT.

T2-Weighted Liver MRI Using the MultiVane Technique at 3T: Comparison with Conventional T2-Weighted MRI

OBJECTIVE: To assess the value of applying MultiVane to liver T2-weighted imaging (T2WI) compared with conventional T2WIs with emphasis on detection of focal liver lesions. MATERIALS AND METHODS: Seventy-eight patients (43 men and 35 women) with 86 hepatic lesions and 20 pancreatico-biliary diseases underwent MRI including T2WIs acquired using breath-hold (BH), respiratory-triggered (RT), and MultiVane technique at 3T. Two reviewers evaluated each T2WI with respect to artefacts, organ sharpness, and conspicuity of intrahepatic vessels, hilar duct, and main lesion using five-point scales, and made pairwise comparisons between T2WI sequences for these categories. Diagnostic accuracy (Az) and sensitivity for hepatic lesion detection were evaluated using alternative free-response receiver operating characteristic analysis. RESULTS: MultiVane T2WI was significantly better than BH-T2WI or RT-T2WI for organ sharpness and conspicuity of intrahepatic vessels and main lesion in both separate reviews and pairwise comparisons (p < 0.001). With regard to motion artefacts, MultiVane T2WI or BH-T2WI was better than RT-T2WI (p < 0.001). Conspicuity of hilar duct was better with BH-T2WI than with MultiVane T2WI (p = 0.030) or RT-T2WI (p < 0.001). For detection of 86 hepatic lesions, sensitivity (mean, 97.7%) of MultiVane T2WI was significantly higher than that of BH-T2WI (mean, 89.5%) (p = 0.008) or RT-T2WI (mean, 84.9%) (p = 0.001). CONCLUSION: Applying the MultiVane technique to T2WI of the liver is a promising approach to improving image quality that results in increased detection of focal liver lesions compared with conventional T2WI.

The MR imaging diagnosis of liver diseases using gadoxetic acid: Emphasis on hepatobiliary phase

Hepatocyte specific contrast agents including gadoxetic acid and gadobenate dimeglumine are very useful to diagnose various benign and malignant focal hepatic lesions and even helpful to estimate hepatic functional reservoir. The far delayed phase image referred to as the hepatobiliary phase makes the sensitivity of detection for malignant focal hepatic lesions increased, but specificity of malignant diseases, including hepatocellular carcinoma, metastasis and cholangiocarcinoma, characterization remained to be undetermined.

Simultaneous Pancreatic Serous Microcystic Adenoma and Intraductal Papillary Mucinous Tumor of the Pancreas: A Case Report

Serous cystadenomas of the pancreas account for approximately a third of pancreatic cystic neoplasms. Their coexistence with a second tumor is extremely rare. We now report a case of a serous microcystic adenoma combined with an intraductal papillary mucinous tumor of the pancreas in a 69-year-old man. Abdominal computed tomography scans demonstrated an incidental cystic mass in the body with cystic dilatation of the duct in the head of the pancreas. Central pancreatectomy with pancreatico-jejunostomy, and cyst excision of the pancreatic head were performed. Histologic examination demonstrated a serous microcystic cystadenoma in the body coexisting with an intraductal papillary mucinous adenoma in the head of the pancreas. This case study highlights the importance of careful intra-operative and pathologic examination for synchronous pancreatic tumors.

Solitary Fibrous Tumor of the Liver: A Case Report

Solitary fibrous tumor is an uncommon neoplasm of mesenchymal origin that primarily affects the pleura. This tumor has been rarely found in liver parenchyma. We present an additional case of a solitary fibrous tumor in the liver of a 46-year-old woman. A contrast-enhanced magnetic resonance image revealed a well-defined round hepatic mass with strong homogeneous enhancement on arterial phase imaging. The tumor was composed of cytologically bland spindle cells with alternating hypercellular and hypocellular sclerotic areas. Immunohistochemistry indicated that the tumor cells were positive for vimentin, CD34, CD99 and smooth muscle actin, but negative for cytokeratin, human melanoma black 45, CD117, bcl-2, and S-100 protein.

Solitary Fibrous Tumor of the Liver: A Case Report

Solitary fibrous tumor is an uncommon neoplasm of mesenchymal origin that primarily affects the pleura. This tumor has been rarely found in liver parenchyma. We present an additional case of a solitary fibrous tumor in the liver of a 46-year-old woman. A contrast-enhanced magnetic resonance image revealed a well-defined round hepatic mass with strong homogeneous enhancement on arterial phase imaging. The tumor was composed of cytologically bland spindle cells with alternating hypercellular and hypocellular sclerotic areas. Immunohistochemistry indicated that the tumor cells were positive for vimentin, CD34, CD99 and smooth muscle actin, but negative for cytokeratin, human melanoma black 45, CD117, bcl-2, and S-100 protein.

Xanthogranulomatous Pancreatitis Combined with Intraductal Papillary Mucinous Carcinoma In Situ

Xanthogranulomatous lesion is a rare condition in which lipid-laden histiocytes are deposited at various locations in the body. Xanthogranulomatous pancreatitis (XGP) associated with an intraductal papillary mucinous tumor (IPMT) is extremely rare. In this study, we described a case of XGP associated with IPMT and include a review of the literature. A pancreatic cystic mass was detected in a 72-yr-old woman by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed and diagnosis of XGP combined with intraductal papillary mucinous carcinoma in situ was made. After 13 months of follow-up, the patient is in good health without any evidence of tumor recurrence. Although XGP associated with IPMT is rare, we suggest that such cases should be brought to the attention of clinical investigators, as it may produce clinical features that mimic pancreatic cancer.

Paddle-skin Coupling Material Usage in Emergency Institutes in South Korea

PURPOSE: While the use of coupling material (CM) during defibrillation is known to decrease transthoracic impedance more so than other materials elsewhere, the situation in Korea is unclear. The study assessed the use of paddleskin CM during defibrillation in South Korean emergency institutes (EIs) and measured the impedances. METHODS: From October 15 to October 19, 2009, 112 EIs (all of regional emergency medical centers (EMCs), specialized care centers, and local EMCs) were surveyed. Institute members were queried about their current use of paddleskin CMs during defibrillation. Indications for use were studied by means of a World Wide Web search, descriptions on the CM packaging, and telephone conversations with CM manufacturers and related people. Impedance measurements were recorded from April 13 to August 3, 2009. RESULTS: During defibrillation, 27 different CMs were used in the 108 EIs. Only nine institutes used CMs directly for defibrillation. Impedence of nine CMs could not be measured. The impedance values were 1.69, 1.71, 2.00, and 6.12 ohm for four CMs used for defibrillation; 6.66 and 11.94 ohm for two CMs used for electrodes; 9.71, 9.82, 11.57, 13.68, 13.89, 14.36, 18.31, and 19.66 ohm for eight CMs used for ultrasonography; and 14.05, 17.71, 35.44, and 41.15 ohm for four other CMs. CONCLUSION: More education and public information about the use of CMs for defibrillation are needed.

Cerebellar Activation Related to Various Tasks Using fMRI

PURPOSE: Although it's been known for half a century that unique structures have evolved in the cerebellum and they then became greatly enlarged in the human brain, the function of these structures still remains unknown. The purpose of this study was to assess cerebellar activation during motor, sensory, word generation, listening comprehension, and working memory tasks with using functional magnetic resonance imaging (fMRI). MATERIALS AND METHODS: Eleven healthy right-handed subjects (Male: female, 6:5, mean age: 27.4years) were imaged on a Siemens 1.5T scanner. Whole brain functional maps were acquired using BOLD EPI sequences in the axial plane. Each paradigm consisted of five epochs of activation vs. the control condition. The activation tasks consisted of left finger complex movement, sensory stimulation of the left hand, word generation, listening comprehension, and working memory tasks. The reference function was a boxcar waveform. The activation maps were thresholded at p = 0.001. SPM 5 evaluated the activated areas and responses within the cerebellum. RESULTS: Cerebellar activation was observed on motor task, word generation task, and working memory task. There were 949 activated areas and the mean fitted and adjusted response was 0.68 during the motor task. There were 319 activated areas and the mean fitted and adjusted response was 0.15 during the word generation task. There were 330 activated areas and the mean fitted and adjusted response was 0.26 during the working memory task. CONCLUSION: Our results suggest that the cerebellum is involved in a variety of functional tasks, including motor, word generation, and working memory tasks. However, during the motor task, the cerebellum showed a large activated area and a high response. Cerebellar function can be evaluated by fMRI.

Congenital Absence of the Horizontal Segment of the Left Portal Vein

As living-donor liver transplant techniques develop, variations in the portal vein are seen in approximately 20% of the population. However, congenital absence of the horizontal segment of the left portal vein is very rare and has not been reported in Korea. We present a case with a congenital absence of the horizontal segment of the left portal vein that was detected during an evaluation for a living donor liver transplantation, with a review of the relevant literature.

Histiocyte-Rich Reactive Lymphoid Hyperplasia of the Liver: Unusual Morphologic Features

Reactive lymphoid hyperplasia (RLH) of the liver is a rare entity and has also been termed nodular lymphoid lesion or pseudolymphoma of the liver. We report a case of hepatic RLH exhibiting unusual histiocyte-rich histologic features in a 47-yr-old woman in conjunction with a renal cell carcinoma. A follow-up computed tomography scan was done 14 months after a right radical nephrectomy for renal cell carcinoma revealed a nodular lesion in segment 5 of the liver. The lesion was interpreted as metastatic renal cell carcinoma or hepatocellular carcinoma based on the history of the patient and radiologic findings. Wedge resection of segment 5 was done with sufficient distance from the mass. Microscopically, the lesion was composed predominantly of peculiar histiocytic proliferation and was characterized by lymphoid aggregates forming a lymphoid follicle with germinal centers. The present case and prior cases reported in the literature suggest that RLH of the liver appear to be a heterogenous group of reactive inflammatory lesions that are often associated with autoimmune disease or malignant tumors.

Small Malignant Hepatic Tumor Detection in Gadolinium- and Ferucarbotran-Enhanced Magnetic Resonance Imaging: does Combining Ferucarbotran-Enhanced T2*-Weighted Gradient Echo and T2-Weighted Turbo Spin Echo Images have Additive Efficacy?

OBJECTIVE: To determine if a combination of ferucarbotran-enhanced T2*weighted-gradient echo (T2*W-GRE) and T2-weighted turbo spin echo (T2W-TSE) images in gadolinium- and ferucarbotran-enhanced MRI has additive efficacy compared to each image alone for detecting small (< or = 2.0 cm) hepatocellular carcinoma (HCC) lesions in a group of cirrhotic patients and metastases in a group of non-cirrhotic patients. MATERIALS AND METHODS: Two readers retrospectively analyzed gadolinium- and ferucarbotran-enhanced T2*W-GRE, T2W-TSE, and combined T2*W-GRE/T2W-TSE images of 119 patients with 157 HCCs and 32 patients with 98 metastases. The diagnostic accuracy and sensitivity for each image set and the combined set were evaluated using the alternative-free response receiver operating characteristic method. RESULTS: The mean area under the curve value of the combined set (0.966) tended to be better than that for each individual image set (T2W-TSE [0.910], T2*W-GRE [0.892]). Sensitivities in the combined set were higher than those in each individual image set for detecting HCC (mean, 93.0% versus 81.6% and 86.7%, respectively, p < 0.01). Sensitivities in the combined set and the T2W-TSE set were the same for detecting metastases, and both were higher than the sensitivity seen in the T2*W-GRE set (mean, 97.5% versus 85.2 %, p < 0.01). CONCLUSION: Combining ferucarbotran-enhanced T2*W-GRE and T2W-TSE has additive efficacy for detecting HCC in cirrhotic patients, but T2W-TSE is preferred for detecting metastases in non-cirrhotic patients.

Impact of Visceral Fat on the Metabolic Syndrome and Nonalcoholic Fatty Liver Disease

Visceral fat has been reported to be associated with nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome (MetS). We assessed the prevalence of both NAFLD and the MetS, measured visceral fat thickness VFT), and estimated the physical activity indexes of 224 relatively healthy hospital workers. We also investigated the associations between both VFT and physical activity index and each of NAFLD and the MetS. The MetS was diagnosed according to the guidelines outlined by the Adult Treatment Panel III, and NAFLD was diagnosed by ultrasonography. Subjects with hepatitis B and C infections and those reporting moderate alcohol consumption were excluded from the study. The prevalence of the MetS was 11.6% and that of NAFLD was 41.5%. Many subjects with the MetS had NAFLD (73.1%), and some subjects with NAFLD (20.4%) also had several components of the MetS (p=0.001). VFT was significantly increased by both the addition of components of the MetS and the severity of NAFLD (p<0.001). In addition, VFT was independently associated with NAFLD (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02-1.19) in subjects with more than 2 components of the MetS. In contrast, habitual physical activity was reversely associated with NAFLD (OR, 0.29; 95% CI, 0.10-0.87). In conclusion, an increased visceral fat content and reduced physical activity could be not only biological markers but also therapeutic targets in the treatment of NAFLD and the MetS.

Expression of Caveolin in Hepatocellular Carcinoma: Association with Unpaired Artery Formation and Radiologic Findings / 대한간학회지

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is becoming one of the common malignant tumors worldwide, and it is characterized by its high vascularity. Caveolin is the major structural protein in caveolae, which are small omega-shaped invaginations within the plasma membrane. Caveolin has been implicated in mitogenic signaling, oncogenesis and angiogenesis. The expression of caveolin-1 and -2 in HCC and its potential relationship with angiogenesis has not been examined. METHODS: Paraffin sections of 35 HCC specimens were immunostained with caveolin-1, caveolin-2, alpha-smooth muscle actin, and CD34 antibodies. In addition, the expression of caveolin-1 and -2 mRNA in HCC was examined. The relationship between the radiological findings and the number of unpaired arteries and microvessel density (MVD) was also investigated. RESULTS: Caveolin-1 and -2 were expressed in the sinusoidal endothelial cells in 20 out of 35, and 18 out of 35 HCC specimens, respectively. Caveolin-1 and -2 were also expressed in the smooth muscle cells of the unpaired arteries in 26 out of 35, and 18 out of 35 HCC specimens, respectively. Increased expression of caveolin-1 and -2 mRNA was detected in 26.7% and 33.3% of the tumor specimens, respectively, compared with the corresponding non-tumorous adjacent liver tissues. There was a significant correlation between expression of caveolin-1, -2 in the smooth muscle cells of unpaired arteries and the number of unpaired arteries. The number of unpaired arteries in HCCs was found to be associated with the degree of contrast enhancement in the arterial phase imaging. However, it did not correlate with the degree of MVD. CONCLUSIONS: These findings suggest that the expression of caveolin-1, -2 is associated with the formation of unpaired arteries in HCC. In addition, there is a correlation between the degree of contrast enhancement of the HCC in the arterial phase image and the number of unpaired arteries.

The Usefulness of High-Resolution Three-Dimensional Dynamic MR Imaging with Sensitivity Encoding for Evaluating Extrahepatic Bile Duct Cancer

PURPOSE: We assessed the usefulness of high-resolution 3D dynamic MR imaging with sensitivity encoding (mSENSE) for evaluating bile duct cancer. MATERIALS AND METHODS: Twenty-three patients with extrahepatic bile duct cancer underwent multiphasic 3D GRE MRI, including two delayed phases without and with mSENSE. The first delayed phases were obtained with volumetric interpolated breath-hold imaging (VIBE) and then the higher in-plane resolution images (320x168) were obtained using mSENSE. The two delayed phase images were compared quantitatively by measuring the signal-to-noise ratio (SNR) of liver and tumor, the liver-visceral fat contrast and the tumor-visceral fat contrast-to-noise ratio (CNR); the two delayed phase images were compared qualitatively by evaluating the sharpness of the hepatic vessels and bile duct, the artifacts and the conspicuity of bile duct cancer. RESULTS: The quantitative results with mSENSE image were significantly better than those with conventional VIBE. Though the clarity of the intrahepatic vessels and the intrahepatic bile duct, and the artifacts did not differ significantly between the two images (p>0.05), the clarity of the extrahepatic vessels, the extrahepatic bile duct and the bile duct cancer were better on the mSENSE image than on the VIBE (p<0.05). CONCLUSION: The higher in-plane resolution 3D GRE image obtained with mSENSE was of a better image quality than the conventional VIBE images. This technique shows promise for use as a comprehensive exam for assessing bile duct cancer.

Hepatitis Viral Infection and Carotid Intima-Media Thickness

BACKGROUND: Carotid atherosclerosis has been known to be associated with systemic inflammatory status. The present study aimed to investigate the relationship between hepatitis viral infection or vaccination and carotid atherosclerosis in a relatively healthy population. METHODS: A cross-sectional study was performed in 281 subjects (mean age+/-SD, y; 43.8+/-7.2) in the Chonbuk national university hospital. All the participants were examined for the carotid intima-media thickness (IMT) in both common carotid, carotid bulb, and internal carotid arteries. Hepatitis B surface antigen (HBsAg) and IgG antibodies against hepatitis B and C virus (anti-HBs and anti-HCV) were determined by enzyme linked immunosorbent assays. RESULTS: Twelve subjects (4.3%) were HBsAg seropositive and 6 (2.1%) were anti-HCV positive but the positivity did not affect the mean carotid IMT. However, the hepatitis B-exposure group including both the HBsAg positive and anti-HBs positive without vaccination history showed a significantly higher carotid IMT (mean+/-SD, mm; 0.757+/-0.107 vs. 0.728+/-0.105, P=0.031), even after adjusting for the potential confounders. And, in the subgroup having anti-HBs, the carotid IMT was lower in the hepatitis B vaccinated subjects than in the others (0.725+/-0.103 vs. 0.760+/-0.111, P=0.019). CONCLUSIONS: Subjects exposed to the hepatitis B pathogen, even though they had anti-HBs, showed the higher carotid IMT, and the participants with a vaccination history demonstrated the lower IMT values. Subsequent study in a large representative population might be needed to further delineate the characteristic associations.