Agenesis of the Right Lobe of the Liver / 대한간학회지

Agenesis of the right lobe of the liver is an extremely rare anomaly of the liver, and few cases are reported in the literature. Most of the patients with this anomaly are accompanied by additional anormalies such as retrohepatic or suprahepatic gallbladder and other biliary tract diseases, including cholelithiasis, carcinoma of the gallbladder and portal hypertension. The diagnosis of this rare anatomical variant was established by ultrasonography and computed tomography. The radiological findings, clinical presentation, and differential diagnosis are reviewed.

A Relationship Between Amount of Joint Effusion, Disk Displacement and Presence of Pain in theTemporomandibular Joint: MR Imaging

PURPOSE: To correlate MR findings of amount of temporomandibular joint effusion with joint pain and disk displacement. MATERIALS AND METHODS: In 57 patients, 114 temporomandibular joints with symptoms of disorder(presence of clinical pain) were imaged. Closed and open mouth sagittal spin echo (SE) T1-weighted images (WI) and fast spin echo (FSE) T2-WI were obtained. We classified the amount of joint effusion into grades. Joint effusion was classified as either Grade I, II or III, as follours : in sagittal FSE T2-WI, a long diameter of joint effusion shorter than 1/3 of the diameter of the convex margin of temporal eminence was grade I; longer than 2/3 was grade III; between grade I and III was grade II. Disk displacement was classified as either with or without reduction in the open mouth position. These findings were correlated with one another and statistically analyzed. RESULTS: In 29 cases with joint pain (37%) and in 34 cases without pain (63%) there was no evidence of joint effusion; there were, however, more grade I joint effusion cases with pain (14 ; 60.9%) than without pain (9 : 39.1%). Cases of joint pain increased in proportion to grade of joint effusion, which was statistically significant (p<0.05). In joints without disk displacement, the largest grouping was that which showed no effusion (39 ; 72.2%) ; no joints showed grade III effusion. Cases of joint effusion decreased in proportion to grade of effusion. In joints with disk displacement, cases of joint effusion tended to increase in proportion to the grade of effusion. CONCLUSION: MR findings of amount of temporomandibular joint effusion correlate with joint pain and anterior disk displacement.

Analysis of Prognostic Factors in Patients with Hepatocellular Carcinoma after Transcatheter Hepatic Arterial Chemoembolization(TAE)

PURPOSE: To evaluate long-term survival rates and prognostic factors of patients with hepatocellularcarcinoma after TAE. MATERIALS AND METHODS: 225 patients with hepatocellular carcinoma treated with TAE between January 1988 and December 1994 were studied. Hepatocellular carcinoma was diagnosed either histologically(n=13) orclinically on the basis of findings characteristic for hepatocellular carcinoma obtained using such as diagnostic imaging methods such as ultrasonography, CT, MRI, and angiography as well as on the basis of high serumalpha-fetoprotein level(n=212). TAE was carried out between one and six times(mean, 1.4 time) using a mixture of lipiodol and Adriamycin, together with Gelfoam. Cumulative survival rates from the day of the first TAE were obtained by the Kaplan-Meier method. Parameters likely to influence the prognosis were subjected to univariate analysis using the log-rank test RESULTS: Cumulative survival rates at the end of the first, second, third, fourth, and fifth year were 55.9%, 32.6%, 21.9%, 17.9%, and 15.0%, respectively. The mean survival time was 727+/-76 days. Several factors, including Child-Pugh classification, Okuda's stage, tumor size, presence of portalvein invasion by tumor, of arterio-portal shunt, and of extra hepatic metastases, catheter selection level, and number of TAE showed significant correlation with the outcome. Degrees of Lipiodol accumulation in a tumor onfollow up CT were also correlated with survival rates. CONCLUSION: TAE is an effective measure for prolonging the patient's life expectancy and evaluation of prognostic factor is helpful for prognosis and in deciding on the optimal therapeutic modality.

MR imaging of Kienbock's Disease

PURPOSE: To evaluate the MRI appearance of Kienbock's disease and correlate this with radiographic findings. MATERIALS AND METHODS: Thirteen clinically confirmed cases of 12 patients with kienbock's disease wereretrospectively reviewed. The significance of signal intensity and pattern of Kienbock's disease on MR images was evaluated and the findings on MR images were compared with radiographic stages classified by Lichtman. Enhanced MR images were abtained in four cases. RESULTS: Lichtman's stage I accounted for one case; stage II, two; stage III, eight; stage IV, two. On T1-weighted MR images, the lunate showed focal low signal intensity in the stage I caseand in one of the two stage II case. Eleven wrists demonstrated a generalized loss of lunate signal. On T2-weighted images, the stage I case showed focal high signal intensity. In stage II, one showed focal low signal intensity and the other exhibited generalized low signal intensity with a high spot area. In stage III, five ofeight cases showed generalized low signal intensity, and one demonstrated high signal intensity. Two showed a high spot area within the generalized low signal intensity. In stage IV, one showed generalized low signal intensity and the other exhibited high signal intensity. No enhancement was seen in the three lesions with focal orgeneralized low signal intensity both on T1 and T2-weighted images. Conversely, one lesion with low signalintensity on T1-weighted imaes and high signal intensity on T2-weighted images showed contrast enhancement. CONCLUSION: Low signal intensity of the lunate on T1-weighted images is a consistent findings of Kienbock's disease. However, further studies such as follow-up MRIs, or pathologic correlation studies and MR contrast enhancement studies will be necessary to evaluate the sighificance of high signal intensity on T2-weighted images.

Procedure-Related Complications of Transjugular Intrahepatic Portosystemic Shunt (TIPS) and Its Clinical Significance

PURPOSE: The purpose was to evaluate the procedure-related complications of the TIPS and its clinical significance. MATERIALS AND METHODS: The materials consisted of 52 patients who had 57 TIPS procedures for the management of variceal bleeding due to portal hypertension. To detect the occurrence of complications during transhepatic needle puncture(from hepatic vein to the portal vein), contrast material was injected with the withdrawl of the puncture needle. RESULTS: Procedure-related complications occurred in 28 patients (54%) among 52 patients. The corn lications were biliary tree puncture(15 cases), transperitoneal puncture(14 cases), stent malposition(3 cases) stent migration(1 case), hepatic arteries puncture(1 case), splenic vein perforation(1 case), and paroxysmal tricular tachycardia(1 case). Three patients had acute stent thrombosis with rebleeding immediately after procedure. The procedure was repeated in two patients. One patient was expired due to rebleeding. CONCLUSION: The procedure related complications were clinically insignificant in most instances, when stent thrombosis or proxysmal ventricular tachycardia was developed.