US LI-RADS visualization score: diagnostic outcome of ultrasound-guided focal hepatic lesion biopsy in patients at risk for hepatocellular carcinoma

Purpose@#This study investigated the diagnostic outcome of ultrasound (US)-guided focal hepatic lesion biopsy in patients at risk for hepatocellular carcinoma (HCC) and evaluated the US visualization score as a risk factor for non-diagnostic results. @*Methods@#We retrospectively evaluated 208 focal hepatic lesions in 208 patients who underwent US-guided biopsy in 2016. Using the US Liver Imaging Reporting and Data System version 2017, each exam was assigned a US visualization score (A, B, or C). Final diagnoses were made using pathology reports, and biopsy results were categorized as diagnostic or non-diagnostic. Univariable and multivariable analyses were performed to determine risk factors for non-diagnostic results, including US visualization score and other clinical covariates. @*Results@#Of the 208 lesions, 85.1% were diagnostic and 14.9% were non-diagnostic. The rates of non-diagnostic results were 8.9%, 25.5%, and 57.1% for scores of A, B, and C, respectively. In the univariable analysis, scores of B or C were associated with a significantly higher rate of nondiagnostic results than scores of A (58.1% vs. 24.9%, P<0.001). In the multivariable analysis, US visualization score of B or C (adjusted odds ratio [aOR], 2.7; P=0.027), high-risk needle pathway usage (aOR, 5.7; P=0.001), and lesion size ≤2.0 cm (aOR, 2.7; P=0.024) were independent risk factors for non-diagnostic results. @*Conclusion@#US-guided biopsy had a high diagnostic yield for focal hepatic lesions in patients at risk for HCC. US visualization score of B or C, lesion size ≤2.0 cm, and high-risk needle pathway usage were independent risk factors for non-diagnostic results.

Percutaneous Radiofrequency Ablation for Metachronous Hepatic Metastases after Curative Resection of Pancreatic Adenocarcinoma

OBJECTIVE: To retrospectively evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma who had previously received curative surgery.MATERIALS AND METHODS: Between 2002 and 2017, percutaneous RFA was performed on 94 metachronous hepatic metastases (median diameter, 1.5 cm) arising from pancreatic cancer in 60 patients (mean age, 60.5 years). Patients were included if they had fewer than five metastases, a maximum tumor diameter of ≤ 5 cm, and disease confined to the liver or stable extrahepatic disease. For comparisons during the same period, we included 66 patients who received chemotherapy only and met the same eligibility criteria described.RESULTS: Technical success was achieved in all hepatic metastasis without any procedure-related mortality. During follow-up, local tumor progression of treated lesions was observed in 38.3% of the tumors. Overall median survival and 3-year survival rates were 12 months and 0%, respectively from initial RFA, and 14.7 months and 2.1%, respectively from the first diagnosis of liver metastasis. Multivariate analysis showed that a large tumor diameter of > 1.5 cm, a late TNM stage (≥ IIB) before curative surgery, a time from surgery to recurrence of < 1 year, and the presence of extrahepatic metastasis, were all prognostic of reduced overall survival after RFA. Median overall (12 months vs. 9.1 months, p = 0.094) and progression-free survival (5 months vs. 3.3 months, p = 0.068) were higher in the RFA group than in the chemotherapy group with borderline statistical difference.CONCLUSION: RFA is safe and may offer successful local tumor control in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma. Patients with a small diameter tumor, early TNM stage before curative surgery, late hepatic recurrence, and liver-only metastasis benefit most from RFA treatment. RFA provided better survival outcomes than chemotherapy for this specific group with borderline statistical difference.

Ultrasound-Guided Intraoperative Radiofrequency Ablation and Surgical Resection for Liver Metastasis from Malignant Gastrointestinal Stromal Tumors

OBJECTIVE: To evaluate the effectiveness, safety, and feasibility of intraoperative radiofrequency ablation (IORFA) under ultrasound guidance for the treatment of liver metastases from gastrointestinal stromal tumors (GISTs). MATERIALS AND METHODS: From August 2009 to February 2017, 24 patients with liver metastases of GISTs underwent IORFA, 14 underwent concurrent IORFA and primary GIST resection, and 10 underwent IORFA to treat hepatic recurrence after previous primary GIST resection. Seventy-six hepatic metastases were treated, of which 47 were surgically resected and 29 underwent IORFA. All included patients received imatinib therapy as standard treatment before and after IORFA or surgical resection. A retrospective medical record review was conducted, and follow-up data were collected. Technical success and effectiveness, overall and GIST-specific survival, and complications were assessed. RESULTS: The mean follow-up duration was 50.7 ± 34.7 months. The technical success rate of IORFA was 100%. New metastases developed in three of the 24 patients (12.5%) following a complete response 16, 51, and 95 months after IORFA, respectively. The cumulative one-, three-, and five-year overall survival rates were 100, 94.4, and 87.7%, respectively. The one-, three-, and five-year GIST-related survival rates were 100, 94.4, and 94.4%, respectively. Two major complications (biliary stricture and hepatic abscess) were observed. CONCLUSION: IORFA appears to be a feasible and safe treatment option for liver metastasis in patients with primary GISTs. In addition, IORFA and surgical resection may be complementary, helping to obtain complete response in cases of otherwise inoperable liver metastases secondary to GISTs.

Prognostic Factors in Terms of the Number of Metastatic Nodules in Patients With Colorectal Cancer Liver Metastases

PURPOSE: The hepatic resection is the gold-standard treatment for patients with colorectal-cancer liver metastases (CLM). This study aimed to identify prognostic factors in patients with synchronous CLM who underwent a surgical curative (R0) resection with respect to the number of metastatic nodules. METHODS: Of 1,261 CLM patients treated between January 1991 and December 2010, 339 who underwent a R0 resection for synchronous CLM were included in this retrospective analysis. Patients were grouped according to the number of CLM nodules: 1-2 CLM nodules, n = 272 (group 1) and 3-8 CLM nodules, n = 67 (group 2). RESULTS: The 5-year progression-free survival (PFS) rate in group 1was better than that in group 2 (P = 0.020). The multivariate analysis identified lymph-node metastasis (N2), lymphovascular invasion (LVI), and three or more CLM nodules as independent poor prognostic factors for PFS in all patients and lymph-node metastasis (N2) and LVI as independent poor prognostic factors for patients in group 1. No independent prognostic factors were identified for patients in group 2. CLM treatment method and neoadjuvant chemotherapy were not associated with survival. CONCLUSION: Three or more metastatic nodules, lymph-node metastasis (N2), and LVI were independent poor prognostic factors for PFS in patients with synchronous CLM who underwent a R0 resection. The latter 2 factors were also independent prognostic factors for PFS in patients with less than 3 CLM nodules; however, in patients with three or more CLM nodules, the prognosis for PFS may be related only to liver metastasis.

Test for the Accreditation of Ultrasound Practices using Abdominal Phantom: Preliminary Study Intended for Radiology Residents

PURPOSE: To objectively evaluate examiner's performance in abdominal ultrasonography using body phantom and adjustment of an equipment. MATERIALS AND METHODS: Twenty four radiology residents (six per year of training) independently performed upper abdominal ultrasonography of an ABDFAN phantom, which is similar to human anatomy. Duration of each examination was measured. By consensus, three experienced abdominal radiologists evaluated the management of ultrasonographic equipment (annotation of scan area, depth control, gain and time-gain compensation control, focus control, and occurrence of artifact) and the acquisition of 15 standard images. They scored 5 points per item, for a total of 100 points. RESULTS: The mean score for management of ultrasonographic equipment was 19.17, and 62.50 for acquisition of standard images. The total mean score was 81.67. A significant difference in the total mean score was observed between first grade residents, with a score of 64.17, and other residents, with a score over 85. Mean examination time was 10.9 minutes. In management of ultrasonographic equipment, annotation of the scan area received a lower score of 1.04 points. In the acquisition of standard images, the mean score for an intercostal scan of the right hepatic lobe, including the right hepatic vein, was lowest, at 1.88, whereas those for transverse scan of the right hepatic lobe and of the pancreas were highest, at 5 points. CONCLUSION: As the total mean score by residents, except for first grade residents, was over 85, the assessment items presented in this study can be used as objective criteria in the test for accreditation of ultrasound practices.

Trace of Electrodes on Follow-up Liver Ultrasonography After Percutaneous Ultrasound-Guided Radiofrequency Ablation: "Tram-Track Sign"

PURPOSE: The purpose of this study is to report on the trace of the electrode used for a radiofrequency ablation (RFA) for a hepatic tumor on US images and to determine its frequency, factors affecting it, and its usefulness. MATERIALS AND METHODS: Twenty three patients had 44 RFA zones in the liver. Two parallel echogenic lines in the RFA zone were regarded as the trace of electrode and classified into four groups according to length. Parametric variables, including diameter of the tumor, location of the RFA zone, type of RFA electrode, length of the exposed tip, and the interval between the RFA procedure and follow-up US examination, were correlated with grades. RESULTS: Mean diameter of tumors was 2 cm and 28 of 44 RFA zones were located in the right hepatic lobe. Forty single and four cluster electrodes were used. Exposed tips measured 2 cm (n = 8), 2.5 cm (n = 4), and 3 cm (n = 32) in length. Two parallel echogenic lines more than 1 cm in length were detected in 23 of 44 RFA zones (52%). The grade of the trace showed negative correlation with the interval (p = 0.014). CONCLUSION: According to the results of our study, the frequency of traces of the electrodes (two parallel echogenic lines more than 1 cm in length, named the "tram-track sign") was 52%, and these fade over time. This sign could be useful as a landmark for accurate targeting in cases of local tumor progression.

Osler-Weber-Rendu disease presenting with hepatocellular carcinoma: radiologic and genetic findings / 대한간학회지

This is a case report of a 68-year-old man with hepatocellular carcinoma (HCC) accompanied by hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, and hepatic vascular malformation. HHT is an autosomal dominant disorder of the fibrovascular tissue that is characterized by recurrent epistaxis, mucocutaneous telangiectasias, and visceral arteriovenous malformations. HHT is caused by mutation of the genes involved in the signaling pathway of transforming growth factor-beta, which plays an important role in the formation of vascular endothelia1. Hepatic involvement has been reported as occurring in 30-73% of patients with HHT. However, symptomatic liver involvement is quite rare, and the representative clinical presentations of HHT in hepatic involvement are high-output heart failure, portal hypertension, nodular regenerative hyperplasia, and symptoms of biliary ischemia. Some cases of HCC in association with HHT have been reported, but are very rare. We present herein the characteristic radiologic and genetic findings of HHT that was diagnosed during the evaluation and treatment of HCC.

Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases / 대한외과학회지

PURPOSE: To evaluate the comparative therapeutic efficacy of radiofrequency ablation (RFA) and hepatic resection for the treatment of colorectal liver metastasis (CRLM). METHODS: Between 1996 and 2008, 177 patients underwent RFA, 278 underwent hepatic resection and 27 underwent combination therapy for CRLM. Comparative analysis of clinical outcomes was performed including number of liver metastases, tumor size, and time of CRLM. RESULTS: Based on multivariate analysis, overall survival (OS) correlated with the number of liver metastases and the use of combined chemotherapy (P or = 3 cm, DFS was significantly lower in the RFA group as compared with the resection group (P = 0.015). CONCLUSION: The results indicate that RFA may be a safe alternative treatment for solitary CRLM less than 3 cm, with outcomes equivalent to those achieved with hepatic resection. A randomized controlled study comparing RFA and resection for patients with single small metastasis would help to determine the most efficient treatment modalities for CRLM.

Quality Assessment of Hepatic Ultrasound Images Examined After a Medical Check-up

PURPOSE: This study was designed to determine problems associated with liver ultrasonography for healthy individuals after a medical examination by the evaluation of sonographic images. MATERIALS AND METHODS: A total of 353 patients randomly selected from 341 institutions underwent liver ultrasonography. Among the patients, 14 patients were excluded from the study as they possessed digital images that were not accesible (n = 10) or underwent ultrasonography (n = 4) that did not involve the liver. Two experts each with a ten-year experience in the interpretation of ultrasonography analyzed the images with consensus based on the assessment of liver ultrasonography established by the Korean Society of Ultrasound in Medicine. The images of 339 patients consisted of digital images (n =135), films (n = 14) and prints on paper (n = 190). RESULTS: A total of 3514 images (range, 1-39; mean number of images per patient, 10.4) were obtained from 339 patients. Of the patients, there were 232 (68.4%) patients with eight good images and 231 patients had a score greater than 60 points. The mean percent score was 64.9 for general information, 63.8 for technical information and 50.5 for a standard examination. The mean percent score for a longitudinal scan of the common bile duct and vertical scan of the left lobe were low at 20.1 and 28.9, respectively. CONCLUSION: The number of good images was sufficient at 10.4, but patient information was not exact, ultrasonographic equipment was not adjusted and a standard examination was not applied. As these findings were based on examiner ignorance and indifference, education or certification for examiners should be required.

Percutaneous Management of a Bronchobiliary Fistula after Radiofrequency Ablation in a Patient with Hepatocellular Carcinoma

Radiofrequency ablation (RFA) is a minimally invasive, image-guided procedure for the treatment of hepatic tumors. While RFA is associated with relatively low morbidity, sporadic bronchobiliary fistulae due to thermal damage may occur after RFA, although the incidence is rare. We describe a patient with a bronchobiliary fistula complicated by a liver abscess that occurred after RFA. This fistula was obliterated after placement of an external drainage catheter into the liver abscess for eight weeks.

Quality Assessment of Ultrasonographic Equipment Using an ATS-539 Multipurpose Phantom

PURPOSE: To determine the rate of congruence and to standardize assessment of US (ultrasound) phantom images with the use of an ATS-539 multipurpose phantom for US equipment currently utilized in Korea MATERIALS AND METHODS: US phantom images were scanned with a 3.0-5.0 MHz convex transducer and were digitized by use of an analogue-digital converter. Members of a committee with consent evaluated the US phantom images from 108 types of ultrasound equipment. The dead zone, vertical and horizontal measurement, axial/lateral resolution, focal zone, sensitivity, functional resolution and gray scale/dynamic range were evaluated. Congruence or incongruence of ultrasound equipment was determined based on the results of dead zone, axial/lateral resolution and gray scale/dynamic range measurements. Other factors were evaluated for the possibility as criteria with the use of the Mann-Whitney U test and receiver operator characteristic (ROC) curve analysis. RESULTS: The dead zone, axial/lateral resolution and gray scale/dynamic range were 91.7%, 94.4% and 76.9%, respectively, for suitable US equipment. Considering all three factors, 78 types of ultrasound equipment were passed. The congruence rate of focal zone and functional resolution were 62.4% and 69.3% of the US equipment, respectively. CONCLUSION: Of the US equipment, 72.2% of the equipment was acceptable based on the dead zone, axial/lateral resolution, and gray scale/dynamic range measurements as determined with the use of an ATS-539 phantom. Focal zone and 8 mm-functional resolution can be useful as a standard in the assessment of a US phantom image.

Hepatic Hemangiomas with Peritumoral Sparing of Fatty Infiltration in Hepatic Steatosis: Findings on Contrast-enhanced MR Imaging and on Sonography

PURPOSE: We wanted to determine the frequency of peritumoral sparing of fatty infiltration (PTSF) around hepatic hemangioma in hepatic steatosis and to evaluate the finding of these tumors on dynamic contrast-enhanced MR imaging and on sonography. MATERIALS AND METHODS: This study included 76 hemangiomas in 67 patients suffering with hepatic steatosis. A diagnosis of hemangioma was based on the histologic findings, hemangioma SPECT or a compatible enhancement pattern on the dynamic contrast-enhanced MR study. For chemical shifting, PTSF was defined when there wasn't any decrease in signal intensity of the liver parenchyma on the opposed-phase images as compared with the in-phase images, and this intensity appeared as a hyperintense area around the tumor. We evaluated the frequency of PTSF and we analyzed if the presence of PTSF was related to the tumor size, the rapidity of enhancement or an associated arterioportal shunt. Among those, sonographic images were available in 55 hemangiomas. We also evaluated the sonographic appearances of hemangiomas with PTSF. RESULTS: Of the 76 hemangiomas, PTSF was noted on the MR chemical-shift images in 57 hemangiomas (75%). There was no significant relationship between tumor size and the presence of PTSF (p=.578). However, this finding was more frequently found in high-flow hemangiomas than in the slow-flow ones (p=.0038) and it was also related to the presence of associated arterioportal shunt (p=.0158). Sonographically, hemangiomas with PTSF were commonly surrounded by a peritumoral low-echoic area (28/41, 68%); these tumors more frequently showed a thin high-echoic rim on sonography than did the tumors without this finding (p=.0055). CONCLUSION: PTSF is commonly seen in hemangiomas in hepatic steatosis patients. Hepatic hemangiomas with PTSF tend to show rapid enhancement on dynamic MR imaging and this is accompanied by arterioportal shunt. They tend to be seen as an iso- or low-echoic mass with a thin high-echoic rim on sonography, and the mass is commonly surrounded by a peritumoral low-echoic area.

Imaging Findings of Abdominal Extraosseous Plasma Cell Neoplasm

PURPOSE: To evaluate the imaging findings of abdominal extraosseous plasma cell neoplasm. MATERIALS AND METHODS: From April 2000 to January 2005, eight patients (four men, four women; mean age, 50.6 years) with pathologically proved, extraosseous plasma cell neoplasm involving the abdominal organs were included in this study. The diagnoses were based on consensus agreement between two radiologists who retrospectively reviewed CT, ultrasonography, and enteroclysis findings. We evaluated the findings by focusing on the location, size, margin, and enhancement pattern of the lesion, and lymphadenopathy on each image. RESULTS: There were multiple myeloma in four patients and extramedullary plasmacytoma in the remaining four. Involved abdominal organs were the liver (n = 4), spleen (n = 4), lymph node (n = 3), stomach (n = 1), small bowel (n = 1), and colon (n = 1). The hepatic involvement of plasma cell neoplasm presented as a homogeneous, well-defined, solitary mass (n = 1), multiple nodules (n = 1), and hepatomegaly (n = 2). Its involvement of the spleen and lymph node appeared as splenomegaly and lymphadenopathy, respectively. Its involvement of the gastrointestinal tract including the stomach, small bowel, and colon, presented as a homogeneous, diffuse wall thickening or mass in the gastrointestinal tract. CONCLUSION: Abdominal extraosseous plasma cell neoplasm involves occasionally the liver, spleen, and lymph node, and rarely the gastrointestinal tract. When we encounter a well-defined, homogeneous lesion of the abdominal organs in patients diagnosed or suspected as having plasma cell neoplasm, we should consider its involvement of the abdominal organs.

Radiofrequency Ablation of Hepatic Cysts: Case Report

Radiofrequency ablation has been frequently performed on intra-hepatic solid tumor, namaly, hepatocellular carcinoma, metastatic tumor and cholangiocarcinoma, for take the cure. But, the reports of radiofrequency ablation for intrahepatic simple cysts are few. In vitro experiment of animal and in vivo treatment for intrahepatic cysts of human had been reported in rare cases. We report 4 cases of radiofrequency ablation for symptomatic intrahepatic cysts.

Bile Duct Hamartomas: US, CT and MR Findings in Eight Patients, Focusing on the US Findings

PURPOSE: To describe the US, CT and MR findings in eight patients with bile duct hamartomas. MATERIALS AND METHODS: Bile duct hamartomas were diagnosed in eight patients (5 men and 3 women; age range, 41-69 years; mean age, 56 years) by liver biopsy. The US, CT and MR findings were retrospectively reviewed. RESULTS: Ultrasonographically, the bile duct hamartomas presented diffuse inhomogeneous and coarse echo texture with focal lesions, including bright spotty echoes or small hyperechoic nodules (n=7), hypoechoic nodules (n=7) and comet-tail echo (n=3) in seven patients. 16 of the 39 definable hypoechoic nodules that ranged in size from 5 mm to 16mm showed posterior enhancement. CT revealed innumerable hypodense nodules measuring 2-5 mm (n=3), 2-13 mm (n=1), 2-15 mm (n=2) and 2-18 mm (n=1) in seven patients. They were usually irregular in shape and showed no enhancement, but became more apparent after the administration of intravenous contrast medium. The innumerable hypodense nodules on enhanced CT scans were uniformly (n=5) or nonuniformly (n=2) distributed throughout the liver. In four patients, MR images showed multiple small cyst-like lesions 2-13 mm in diameter. These small cystlike lesions were much more apparent on T2-weighted images or MR cholangiography. The diagnosis was made by either core-needle or wedge biopsy. In one patient, a small single lesion on the liver surface was not visible on the imaging studies. Pathologic examination revealed multiple bile duct hamartomas of varying size or microhamartomas. CONCLUSION: Although the bile duct hamartomas on CT and MR presented as numerous intrahepatic, small cyst-like lesions, they on US showed variable findings consisting of inhomogeneous and coarse echo texture with focal lesions, including bright spotty echoes or small hyperechoic nodules, hypoechoic nodules, and comet-tail echoes.

Hepatic Tuberculosis: Unusual CT and Sonographic Findings

A case of infiltrative type of hepatic tuberculosis is presented. Ultrasonography revealed a very ill-margined, heterogenously low echoic lesion in the right hepatic lobe. CT scans demonstrated a very ill-defined, geographic, hypodense lesion with minimal contrast enhancement mimicking cholangiohepatitis or infiltrative tumor in the right hepatic lobe.

Anatomic Variation in Intrahepatic Bile Ducts: an Analysis of Intraoperative Cholangiograms in 300 Consecutive Donors for Living Donor Liver Transplantation

OBJECTIVE: To describe the anatomical variation occurring in intrahepatic bile ducts (IHDs) in terms of their branching patterns, and to determine the frequency of each variation. MATERIALS AND METHODS: The study group consisted of 300 consecutive donors for liver transplantation who underwent intraoperative cholangiography. Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct. RESULTS: The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3). CONCLUSION: The branching pattern of IHDs was atypical in 37% of cases. The two most common variations were drainage of the RPSD into the LHD (11%) and triple confluence of the RASD, RPSD and LHD (10%).

Differential Diagnosis of Benign and Malignant Intraductal Papillary Mucinous Tumors of the Pancreas: MR Cholangiopancreatography and MR Angiography

OBJECTIVE: To compare the usefulness of magnetic resonance cholangiopancreatography (MRCP) and MR angiography (MRA) in differentiating malignant from benign intraductal papillary mucinous tumors of the pancreas (IPMTs), and to determine the findings which suggest malignancy. MATERIALS AND METHODS: During a 6-year period, 46 patients with IPMT underwent MRCP. Morphologically, tumor type was classified as main duct, branch duct, or combined. The diameter of the main pancreatic duct (MPD), the extent of the dilated MPD, and the location and size of the cystic lesion, septum, and communicating channel were assessed. For all types of IPMTs, enhanced mural nodules and portal vein narrowing were evaluated at MRA. RESULTS: Combined-type IPMTs were more frequently malignant (78%) than benign (42%) (p < 0.05). Compared with benign lesions, malignant lesions were larger, and the caliber of the communicating channel was also larger (p < 0.05). Their dilated MPD was more extensive and of greater diameter (p < 0.05), and the presence of mural nodules was more frequent (p < 0.001). CONCLUSION: Combined MRCP and MRA might be useful for the differential diagnosis of malignant and benign IPMTs of the pancreas.

CT Findings of Small Bowel Metastases From Primary Lung Cancer

PURPOSE: To evaluate the CT findings of small bowel metastases from primary lung cancer. MATERIALS AND METHODS: Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. RESULTS: Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in 5 patients. CONCLUSION: CT helps in defining the extent and pattern of small bowel metastases as well as in demonstrating their complication.

CT Imaging Features of Phytobezoar Associated with Small Bowel Obstruction

PURPOSE: The purpose of this study was to evaluate the CT findings of phytobezoar associated with small bowel obstruction. MATERIALS AND METHODS: In 19 patients with phytobezoar associated with small bowel obstruction, two of whom had underlying small bowel disease, we analyzed the morphological characteristics of phytobezoars and changes in the bowel and perienteric regions, as revealed by abdominal Ct imaging. RESULTS: On CT, phytobezoars appeared as single or multiple, gas-containing masses in 17 patients (89%) and as a solid mass without gas in the remaining two (11%). An encapsulating wall was noted in six patients (32%). Among the 17 without underlying small bowel disease, the bowel wall was thickened in 13 (76%) at the obstructed site and/or the bowel proximal to the obstruction. Mesenteric vascular engorgement and haziness were seen in 18 patients (95%) and a small amount of ascites in six (32%). MR images of one patient showed the phytobezoar as a hypointense mass on all sequences. CONCLUSION: CT imaging is useful for the diagnosis of phytobezoar associated with small bowel obstruction.