Cone-Beam Computed Tomography-Hepatic Arteriography as a Diagnostic Tool for Small Hypervascular Hepatocellular Carcinomas: Method and Clinical Implications

OBJECTIVE: This study proposes a novel reference standard for hypervascular hepatocellular carcinomas (HCCs), established by cone-beam computed tomography-hepatic arteriography (CBCT-HA) and two-year imaging follow-up, and discusses its clinical implication on tumor staging and understanding the intrahepatic distant recurrence (IDR) in relation to dynamic computed tomography (CT).MATERIALS AND METHODS: In this retrospective study, 99 patients were enrolled, who underwent CBCT-HA during initial chemoembolization for HCC suspected on CT. All patients underwent chemoembolization and regular clinical and imaging follow-up for two years. If IDR appeared on follow-up imaging, initial CBCT-HA images were reviewed to determine if a hypervascular focus pre-existed at the site of recurrence. Pre-existing hypervascular foci on CBCT-HA were regarded as HCCs in initial presentation. Initial HCCs were classified into three groups according to their mode of detection (Group I, detected on CT and CBCT-HA; Group II, additionally detected on CBCT-HA; Group III, confirmed by interval growth). We assessed the influence of CBCT-HA and two-year follow-up on initial tumor stage and calculated the proportion of IDR that pre-existed in initial CBCT-HA.RESULTS: A total of 405 nodules were confirmed as HCCs, and 297 nodules initially pre-existed. Of the initial 297 HCCs, 149 (50.2%) lesions were in Group I, 74 (24.9%) lesions were in Group II, and the remaining 74 (24.9%) lesions were in Group III. After applying CBCT-HA findings, 11 patients upstaged in T stage, and 4 patients had a change in Milan criteria. Our reference standard for HCC indicated that 120 of 148 (81.1%) one-year IDR and 148 of 256 (57.8%) two-year IDR existed on initial CBCT-HA.CONCLUSION: The proposed method enabled the confirmation of many sub-centimeter-sized, faintly vascularized HCC nodules that pre-existed initially but clinically manifested as IDR. Our reference standard for HCC helped in understanding the nature of IDR and the early development of HCC as well as the clinical impact of tumor staging and treatment decision.

The Role of Dynamic CT for the Differential Diagnosis of Solitary Pulmonary Nodule / 영남의대학술지

BACKGROUND: Malignant pulmonary nodules account for 30 to 40 percent of all solitary pulmonary nodules (SPNs). Therefore, characterization of SPNs is very important for treatment. Recently, dynamic CT has been widely used for tissue characterization and formation of differential diagnoses. The purpose of this study was to evaluate the ability of dynamic CT to formulate the differential diagnosis of SPNs. MATERIALS AND METHODS: Nineteen patients with SPNs underwent dynamic CT (unenhanced scans, followed by a series of images at 20, 40, 60, 80, 100, 120, 140, 160, and 180 sec after intravenous injection of contrast medium). Diagnosis of SPN was performed based on pathologic findings in needle biopsy samples. Peak enhancement, net enhancement, slope of enhancement, and maximum relative enhancement ratio of the SPN were measured on dynamic CT, and Levene's test was performed to assess benignancy and malignancy. RESULTS: Twelve SPNs were confirmed to have malignant pathology. There were no significant differences between benign and malignant nodules with respect to peak enhancement (p=0.787), net enhancement (p=0.135), or slope of enhancement (p=0.698). The maximal enhancement ratio was increased in malignancy compared to benignancy, but the difference was not statistically significant (p=0.094). CONCLUSION: In our study, the hemodynamic characteristics of dynamic CT were not significantly different between benign and malignant nodules. Therefore, long-term studies of larger patient samples are required to confirm our findings.

Hepatic Angiosarcoma Mimicking Cavernous Hemangioma on Dynamic CT

A hepatic angiosarcoma is a rare primary malignant neoplasm, which accounts for only 2% of all primary hepatic tumors. The prognosis of a hepatic angiosarcoma is very poor, and most patients die within a year of the initial diagnosis. We report a case of a hepatic angiosarcoma in a 57-year-old man. Although a dynamic CT had suggested a carvenous hemangioma 12 months earlier, the tumor size increased and spontaneously ruptured, so surgical resection was mandatory. A pathological examination, including immunohistochemical studies, showed positive staining for CD34 and Factor VIII, which confirmed the diagnosis of an angiosarcoma. Although dynamic CT is an excellent modality for the diagnosis of a cavernous hemangioma of the liver, hepatic angiosarcomas should be ruled out in selected cases, because they may present with very similar CT findings to benign hemangioma.

Evaluation of uterine and fibroid blood supplies before and after uterine artery embolization with dynamic enhanced CT scan / 介入放射学杂志

Objective To research the blood supply changes of uterine and fibroid before and after UAE for uterine fibroids.Methods Sixteen patients with symptomatic uterine myoma were treated by Seldinger's bilateral uterine arteries embolization.The same level dynamic enhanced CT scans were undertaken 7 days before and after the procedure with another one 3 months later.The CT values of uterine and fibroid were measured and analyzed. Results 16 cases finished the same level dynamic CT enhancement scans successfully. The dynamic enhanced curves and the CT values showed no significant difference in uterine but had significant difference in fibroids. The fibroids were in a state of ischemia after the procedure.Conclusions Selective uterine arterial embolization is a new safety and effective method for treatment of uterine myoma.

Dynamic Changes of CT Scan of Focal Brain Edema After Head Injury / 中国医师杂志

Objective To study the dynamic changes of posttraumatic focal brain edema. Methods 120 patients who underwent multiple CT scans after head injury with hematoma or brain contusion in our hospital from 1998 to 2002 were enrolled in this study. Their CT image parameters and clinical data were recorded, and statistically analyzed. Results 96.7%(116/120) patients had perihematoma or pericontusion edema. Edema appeared 7 hours after head injury and reached its climax at the ninth day. Edema shape trended taper during its development, and cortex escaped from edema. Conclusion Focal brain edema was very common in the patient with head injury. Taper shape's formation and escape of cortex may mainly attribute to the difference in construction topology and blood supply between cerebral white and gray matter.