The Utility of Three-Dimensional of the T1-Weighted MR Cholangiography with Gd-EOB-DTPA for the Evaluation of a Common Bile Duct Obstruction

PURPOSE: To prospectively assess the utility of the three-dimensional T1 weighted magnetic resonance cholangiography (MRC) with Gd-EOB-DTPA (Primovist(R)) in patients suspected of having a mild common bile duct obstruction. MATERIALS AND METHODS: A total of 30 patients suspected of having a mild common bile duct obstruction were enrolled in this study. A T2 weighted MRC and a three-dimensional T1 weighted MRC with Gd-EOB-DTPA (Primovist(R)) were performed. Within 48 h of the MRC, we performed direct cholangiographies by way of an endoscopic retrograde cholangiography and a surgical cholangiography. Reviews of the data by two experienced radiologists were in consensus. RESULTS: Within 40-60 min of the injection of contrast fluid, the contrast showed the maximum intensity within a common bile duct in 26 of the 30 patients (87%). However, the contrast was poorly visible for as long as 2 hours after injection in 4 of the 30 patients (13%). The sensitivity, specificity, as well as the positive and negative predictive values of the three-dimensional T1 weighted MR cholangiography were 92%, 40%, 88%, and 50%, respectively. CONCLUSION: The three-dimensional, T1 weighted MRC with Gd-EOB-DTPA (Primovist(R)) may be a useful ancillary diagnostic modality for evaluating a patient with mild common bile duct obstruction.

Hepatocellular Carcinoma with Neuroendocrine Differentiation: Clinical and Imaging Findings in Five Patients

PURPOSE: To describe the clinical and imaging findings of hepatocellular carcinoma with neuroendocrine differentiation, which is an extremely rare variant of hepatocellular carcinoma. MATERIALS AND METHODS: We collected five patients who had histopathologically proven hepatocellular carcinoma with neuroendocrine differentiation, and described morphologic feature, enhancement pattern of tumors, extrahepatic manifestation and clinical findings. RESULTS: At CT, the tumor size ranged from 8 to 17 cm (mean : 12 cm) in maximum diameter. The tumor margin was well-defined and smooth in four patients and all tumors were heterogeneously hypoattenuating. Four tumor showed rim enhancement on arterial and portal phases. Local invasion to the portal vein, intrahepatic duct and gallbladder were seen. Extrahepatic manifestations included hepatic metastases, lymph node metastasis. At ultrasonography, the tumor showed heterogeneously hyperechoic in all patients and hypoechoic rim was found in four patients. Of four patients who were followed up, one survived for 16 months after initial diagnosis, while the other three died within 3 months after initial diagnosis. CONCLUSION: As described above, clinical and imaging findings of hepatocellular carcinoma with neuroendocrine differentiation were not specific. However, this rare variant of hepatocellular carcinoma could be considered when hepatic tumor is found in an advanced stage and shows persistent rim enhancement at CT.

The Relationship between Juxtapapillary Duodenal Diverticula and Biliary Diseases: An Evaluation by the Use of MDCT Multiplanar Reformation

PURPOSE: This study was designed to assess the CT findings of a juxtapapillary duodenal diverticulum (JPDD) and to determine if there is an association between a JPDD and biliary disease using MDCT multiplanar reformation (MPR). In addition, a study was performed to determine if MPR is more useful than an axial image only for an analysis of duodenal diverticula. MATERIALS AND METHODS: A total of 49 patients who had JPDD as identified on an MDCT image were retrospectively included in this study. Patients were divided into two groups: patients with biliary disease (Group 1) and patents without biliary disease (Group 2). A total of 23 patients (46.9%) had biliary disease. We analyzed the size, location, content of the diverticulum, compression of the biliary duct by a diverticulum and the site of a duodenal papilla with an axial image only and MPR images. RESULTS: The frequency of biliary disease was increased when the papilla was located inside a diverticulum (p = 0.033). The use of an MPR image was more useful than an axial image alone for the evaluation of a site of a duodenal papilla. CONCLUSION: A JPDD is associated with the development of biliary disease and the risk of biliary disease is increased when the papilla is located in a diverticulum. An MPR image can provide more precise information about the site of a papilla than an axial image for the evaluation of a JPDD.

Splenic Arteriovenous Malformation Manifestated by Thrombocytopenia in Hereditary Hemorrhagic Telangiectasia: A Case Report

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant inherited disease characterized by epistaxis, telangiectases and visceral arteriovenous malformations (AVMs). The involvement of the gastrointestinal tract, liver, lung and cerebrum for HHT has been described, whereas little is known about AVMs of the spleen. We report here the radiological findings of a case of a splenic AVM manifested by thrombocytopenia in HHT.