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Purpose@#This study aimed to evaluate the natural growth of subepithelial tumors of the small bowel detected on CT. @*Materials and Methods@#Consecutive patients who were suspected of having subepithelial tumors of the small bowel between January 2005 and December 2020 were reviewed. Eligible patients with suspected small (< 30 mm) subepithelial tumors on at least two CT evaluations were included in the analysis. The patients’ data on demographic characteristics, tumoral characteristics, and tumoral size changes during the follow-up were collected. @*Results@#This study included 64 patients with suspected small subepithelial tumors (n = 64) of the small bowel. After a median follow-up of 15.8 months, the diameter and volume growth rates were 0.02 mm/month and 1.5 mm3/month, respectively. A significant correlation was observed between the initial size and the growth rate of the small bowel subepithelial tumors. The group of large-sized tumors (initial diameter ≥ 10 mm) tended to show lobulated contours, heterogeneous enhancement, and necrotic changes more frequently than the group of small-sized tumors (initial diameter < 10 mm). @*Conclusion@#Small bowel subepithelial tumors measuring less than 10 mm grew more slowly than those measuring 10–30 mm.
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Renal myxomas are very rare benign tumors. To date, a few cases have been reported in English literature, mostly in pathology and urology journals. Thus, there are few reports on the radiological findings associated with renal myxomas. We report on the imaging findings in a case of renal myxoma in a 62-year-old male. MRI demonstrated a well-defined mass in the left renal sinus, with intermediate high signal intensity on T2-weighted images and low signal intensity on T1-weighted images. The tumor showed gradual enhancement on contrast-enhanced T1-weighted images.
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Purpose@#Curative treatment is challenging in patients with locally advanced rectal cancer and unresectable metastases. The aim of this study was to evaluate the clinical outcomes of short-course radiotherapy (RT) followed by systemic chemotherapy for patients with rectal cancer with mesorectal fascia (MRF) involvement and unresectable distant metastases. @*Methods@#The study included consecutive patients diagnosed as having metastatic mid-to-low rectal cancer treated with short-course RT followed by systemic chemotherapy for conversion radical or palliative surgery between 2014 and 2019 at Gil Medical Center. The patients had primary rectal tumors involving the MRF and unresectable distant metastases. The treatment strategies were determined in a multidisciplinary team discussion. @*Results@#Seven patients (five men and two women) underwent short-course RT (5 × 5 Gy) and preoperative systemic chemotherapy. The median age was 68 years (range, 46–84 years), and the median distance from the anal verge to the primary tumor was 6.0 cm (range, 2.0–9.0 cm). During the median follow-up period of 29.4 months, three patients underwent conversion radical surgery with R0 resection, two underwent palliative surgery, and two could not undergo surgery. No postoperative major morbidity or mortality occurred. The patients who underwent conversion complete radical surgery showed good long-term survival outcomes, with an overall survival time of 29.4–48.8 months and progression-free survival time of 14.7–41.1 months. @*Conclusion@#Short-course RT followed by systemic chemotherapy could provide patients with unresectable stage IV rectal cancer a chance to undergo to conversion radical surgery with good long-term survival outcomes.
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Purpose@#The aim of this study was to compare the diameter and volume of liver metastases on CT images in relation to overall survival and tumor response in patients with gastric cancer liver metastases (GCLM) treated with chemotherapy. @*Materials and Methods@#We recruited 43 patients with GCLM who underwent chemotherapy as a first-line treatment. We performed a three-dimensional quantification of the metastases for each patient. An independent survival analysis using the Response Evaluation Criteria in Solid Tumors (RECIST) was performed and compared to volumetric measurements. Overall survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios following univariate analyses. @*Results@#When patients were classified as responders or non-responders based on volumetric criteria, the median overall survival was 23.6 months [95% confidence interval (CI), 8.63–38.57] and 7.6 months (95% CI, 3.78–11.42), respectively (p = 0.039). The volumetric analysis and RECIST of the non-progressing and progressing groups showed similar results based on the Kaplan-Meier method (p = 0.006) and the Cox proportional hazard model (p = 0.008). @*Conclusion@#Volumetric assessment of liver metastases could be an alternative predictor of overall survival for patients with GCLM treated with chemotherapy.
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Background@#Several noninvasive tools are available for the assessment of nonalcoholic fatty liver disease (NAFLD) including clinical and blood biomarkers, transient elastography (TE), and magnetic resonance imaging (MRI) techniques, such as proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE). In the present study, we aimed to evaluate whether magnetic resonance (MR)-based examinations better discriminate the pathophysiologic features and fibrosis progression in NAFLD than other noninvasive methods. @*Methods@#A total of 133 subjects (31 healthy volunteers and 102 patients with NAFLD) were subjected to clinical and noninvasive NAFLD evaluation, with additional liver biopsy in some patients (n=54). @*Results@#MRI-PDFF correlated far better with hepatic fat measured by MR spectroscopy (r=0.978, P<0.001) than with the TE controlled attenuation parameter (CAP) (r=0.727, P<0.001). In addition, MRI-PDFF showed stronger correlations with various pathophysiologic parameters for cellular injury, glucose and lipid metabolism, and inflammation, than the TE-CAP. The MRI-PDFF and TE-CAP cutoff levels associated with abnormal elevation of serum alanine aminotransferase were 9.9% and 270 dB/m, respectively. The MRE liver stiffness measurement (LSM) showed stronger correlations with liver enzymes, platelets, complement component 3, several clinical fibrosis scores, and the enhanced liver fibrosis (ELF) score than the TE-LSM. In an analysis of only biopsied patients, MRE performed better in discriminating advanced fibrosis with a cutoff value of 3.9 kPa than the TE (cutoff 8.1 kPa) and ELF test (cutoff 9.2 kPa). @*Conclusion@#Our results suggest that MRI-based assessment of NAFLD is the best non-invasive tool that captures the histologic, pathophysiologic and metabolic features of the disease.
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Purpose@#The aim of this study was to compare the diameter and volume of liver metastases on CT images in relation to overall survival and tumor response in patients with gastric cancer liver metastases (GCLM) treated with chemotherapy. @*Materials and Methods@#We recruited 43 patients with GCLM who underwent chemotherapy as a first-line treatment. We performed a three-dimensional quantification of the metastases for each patient. An independent survival analysis using the Response Evaluation Criteria in Solid Tumors (RECIST) was performed and compared to volumetric measurements. Overall survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios following univariate analyses. @*Results@#When patients were classified as responders or non-responders based on volumetric criteria, the median overall survival was 23.6 months [95% confidence interval (CI), 8.63–38.57] and 7.6 months (95% CI, 3.78–11.42), respectively (p = 0.039). The volumetric analysis and RECIST of the non-progressing and progressing groups showed similar results based on the Kaplan-Meier method (p = 0.006) and the Cox proportional hazard model (p = 0.008). @*Conclusion@#Volumetric assessment of liver metastases could be an alternative predictor of overall survival for patients with GCLM treated with chemotherapy.
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Background@#Several noninvasive tools are available for the assessment of nonalcoholic fatty liver disease (NAFLD) including clinical and blood biomarkers, transient elastography (TE), and magnetic resonance imaging (MRI) techniques, such as proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE). In the present study, we aimed to evaluate whether magnetic resonance (MR)-based examinations better discriminate the pathophysiologic features and fibrosis progression in NAFLD than other noninvasive methods. @*Methods@#A total of 133 subjects (31 healthy volunteers and 102 patients with NAFLD) were subjected to clinical and noninvasive NAFLD evaluation, with additional liver biopsy in some patients (n=54). @*Results@#MRI-PDFF correlated far better with hepatic fat measured by MR spectroscopy (r=0.978, P<0.001) than with the TE controlled attenuation parameter (CAP) (r=0.727, P<0.001). In addition, MRI-PDFF showed stronger correlations with various pathophysiologic parameters for cellular injury, glucose and lipid metabolism, and inflammation, than the TE-CAP. The MRI-PDFF and TE-CAP cutoff levels associated with abnormal elevation of serum alanine aminotransferase were 9.9% and 270 dB/m, respectively. The MRE liver stiffness measurement (LSM) showed stronger correlations with liver enzymes, platelets, complement component 3, several clinical fibrosis scores, and the enhanced liver fibrosis (ELF) score than the TE-LSM. In an analysis of only biopsied patients, MRE performed better in discriminating advanced fibrosis with a cutoff value of 3.9 kPa than the TE (cutoff 8.1 kPa) and ELF test (cutoff 9.2 kPa). @*Conclusion@#Our results suggest that MRI-based assessment of NAFLD is the best non-invasive tool that captures the histologic, pathophysiologic and metabolic features of the disease.
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Purpose@#This study aimed to examine the early postprandial changes in gastrointestinal (GI) hormones and hemodynamics in terms of early dumping syndrome after gastrectomy for gastric cancer. @*Materials and Methods@#Forty patients who underwent gastrectomy for gastric cancer and 18 controls without previous abdominal surgery were enrolled. Before and 20 minutes after liquid meal ingestion, blood glucose, glucagon-like peptide-1 (GLP-1), and GLP-2 concentrations and superior mesenteric artery (SMA) and renal blood flow were measured.The patients' heart rates were recorded at 5-minute intervals. All subjects were examined for dumping syndrome using a questionnaire based on Sigstad's clinical diagnostic index. @*Results@#The postprandial increases in blood glucose, GLP-1, and GLP-2 levels as well as SMA blood flow and heart rate were greater in patients who underwent gastrectomy than in controls (all P<0.010). Patients who underwent gastrectomy showed a significantly decreased renal blood flow (P<0.001). Among patients who underwent gastrectomy, distal gastrectomy was a significant clinical factor associated with a lower risk of early dumping syndrome than total gastrectomy (hazard ratio, 0.092; 95% confidence interval, 0.013–0.649; P=0.017).Patients who underwent total gastrectomy showed a greater postprandial increase in blood glucose (P<0.001), GLP-1 (P=0.030), and GLP-2 (P=0.002) levels as well as and heart rate (P=0.013) compared to those who underwent distal gastrectomy. @*Conclusions@#Early postprandial changes in GI hormones and hemodynamics were greater in patients who underwent gastrectomy than in controls, especially after total gastrectomy, suggesting that these changes play a crucial role in the pathophysiology of early dumping syndrome.
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Kaposi's sarcoma (KS) is a multicentric human immunodeficiency virus-associated neoplasm characterized by multiple vascular nodules in the skin, mucous membranes, and viscera. Gastrointestinal acquired immunodeficiency syndrome (AIDS)-related KS is the most common visceral involvement reported in disseminated disease. Here, we present the findings of a rare case of KS involving multiple organs with abdominal pain and active bleeding in the colon. Multiple intraluminal lesions were found in the terminal ileum, sigmoid colon, and rectum by ileocolonoscopy, and in the jejunum and ileum by fluoroscopy. Abdominopelvic CT revealed multiple enhanced flat lesions in the ileum and enlarged lymph nodes. The diagnosis was confirmed by histopathology, and antiretroviral therapy was initiated as the treatment of choice for KS. Owing to the increasing number of AIDS patients, it is essential for radiologists and clinicians to be aware of the imaging characteristics of KS to protect physicians from indiscriminate exposure to AIDS.
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Purpose@#Laparoscopic sleeve gastrectomy (SG) is now frequently performed as a definitive bariatric procedure. The aim of the study was to evaluate the detailed morphology of remnant stomachs after SG with respect to volume and sleeve migration. @*Materials and Methods@#We performed a retrospective review of prospectively collected data on patients that completed a 12-month postop examination, which included CT volumetry of sleeve, and a questionnaire that addressed postop food tolerance. CT volumetry study included total sleeve volume (TSV), tube volume (TV), antral volume (AV), tube/antral volume ratio (TAVR), and the presence of intrathoracic sleeve migration (ITSM). @*Results@#Fifty-five patients were included in this retrospective study. Mean %TWL (% total weight loss) at 12 months postop was 32.8% (14.3-55.5), and mean TSV, TV, AV, and TAVR were 166.6±63.3 ml, 68.9±35.4 ml, 97.7±42.9 ml, and 0.8±0.6 respectively. TSV was not correlated significantly with %TWL at 12 months postop (r=−0.069, P=0.619). Fourteen patients (14/55, 25.5%) showed ITSM by CT. Patients with ITSM had a significantly lower mean GER score (5.1±2.0 vs. 7.3±2.0, P=0.001), a lower total food tolerance score (21.6±3.8 vs. 24.4±4.6, P=0.048), and a higher proportion showed suboptimal weight loss (35.7% vs. 9.8%, P=0.023). @*Conclusion@#Mean TSV was not found to be significantly correlated with %TWL at 12 months postop.Patients with suboptimal weight loss had higher mean TAVR, and the presence of ITSM indicated more frequent GER symptoms, lower food tolerance, and a higher probability of suboptimal weight loss.
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Purpose@#Laparoscopic sleeve gastrectomy (SG) is now frequently performed as a definitive bariatric procedure. The aim of the study was to evaluate the detailed morphology of remnant stomachs after SG with respect to volume and sleeve migration. @*Materials and Methods@#We performed a retrospective review of prospectively collected data on patients that completed a 12-month postop examination, which included CT volumetry of sleeve, and a questionnaire that addressed postop food tolerance. CT volumetry study included total sleeve volume (TSV), tube volume (TV), antral volume (AV), tube/antral volume ratio (TAVR), and the presence of intrathoracic sleeve migration (ITSM). @*Results@#Fifty-five patients were included in this retrospective study. Mean %TWL (% total weight loss) at 12 months postop was 32.8% (14.3-55.5), and mean TSV, TV, AV, and TAVR were 166.6±63.3 ml, 68.9±35.4 ml, 97.7±42.9 ml, and 0.8±0.6 respectively. TSV was not correlated significantly with %TWL at 12 months postop (r=−0.069, P=0.619). Fourteen patients (14/55, 25.5%) showed ITSM by CT. Patients with ITSM had a significantly lower mean GER score (5.1±2.0 vs. 7.3±2.0, P=0.001), a lower total food tolerance score (21.6±3.8 vs. 24.4±4.6, P=0.048), and a higher proportion showed suboptimal weight loss (35.7% vs. 9.8%, P=0.023). @*Conclusion@#Mean TSV was not found to be significantly correlated with %TWL at 12 months postop.Patients with suboptimal weight loss had higher mean TAVR, and the presence of ITSM indicated more frequent GER symptoms, lower food tolerance, and a higher probability of suboptimal weight loss.
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OBJECTIVE: To test the feasibility of non-contrast magnetic resonance imaging (MRI) in a sequential imaging study for characterizing computed tomography (CT)-detected arterial-enhancing nodules that do not washout in patients at risk of hepatocellular carcinoma (HCC).MATERIALS AND METHODS: In this retrospective study, 134 patients (mean age ± standard deviation, 56.8 ± 10.0 years) with 151 arterial enhancing-only nodules measuring up to 2 cm during multiphasic CT that were subsequently evaluated using gadoxetic acid-enhanced MRI in treatment-naïve at-risk patients from three tertiary referral centers were included. Tentative diagnostic criteria for HCC and hepatic malignancy were defined as the presence of one of eight MRI features favoring HCC in combinations of the following sequences: T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), T1-weighted dual gradient-echo in-phase and out-of-phase imaging (Dual-GRE), and hepatobiliary phase imaging (HBP). Typical hemangiomas and arterioportal shunts were excluded from the analysis. Diagnostic performance for HCC and hepatic malignancy was calculated and compared between the abbreviated MRI and full-sequence gadoxetic acid-enhanced MRI.RESULTS: Of 151 nodules (mean size, 1.2 cm) 68 HCCs and 83 non-HCC benignities and malignancies were included. The combination of T2WI, DWI, and Dual-GRE showed per-lesion sensitivity, specificity, and accuracy of 88.2%, 90.4%, and 89.4%, respectively, comparable to those of full-sequence MRI. Applying the same sequence combination to diagnose hepatic malignancy had per-lesion sensitivity, specificity, and accuracy of 86.8%, 97.3%, and 92.1%. In nodules < 1 cm, adding HBP increased sensitivity by up to 13% without compromising the specificity or accuracy.CONCLUSION: The non-contrast MRI protocol comprising T2WI, DWI, and Dual-GRE showed reasonable and comparable performance to full-sequence MRI for discriminating HCC and primary liver malignancies in CT-detected indeterminate arterial enhancing-only nodules in at-risk patients, and can be potentially used for sequential imaging in place of a full-sequence MRI. In nodules < 1 cm, HBP may still be needed to preserve sensitivity.
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Humanos , Carcinoma Hepatocelular , Hemangioma , Fígado , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Atenção TerciáriaRESUMO
PURPOSE@#The aim of this study was to compare the measurements of diameter and volume of hepatic metastases from CT images with the overall survival and tumor response, in patients with unresectable liver metastases of colorectal cancer treated with a targeted agent.@*MATERIALS AND METHODS@#We recruited 43 patients with unresectable liver metastases of colorectal cancer, in whom targeted therapy was used as the first-line treatment. Three-dimensional quantification of the volume of hepatic metastases was performed for each patient. An independent survival analysis using the Response Evaluation Criteria in Solid Tumors guidelines was performed and compared to the volumetric measurement. Overall survival was evaluated using the Kaplan-Meier analysis and compared to the Cox proportional hazard ratios (HRs) following univariate and multivariate analyses.@*RESULTS@#In patients classified as non-progressing and progressing by the volumetric criteria, the median overall survival time was 21 months [95% confidence interval (CI): 491.25–768.75] and 11 months (95% CI: 0–949.42), respectively (p = 0.001). Using a multivariate analysis, we found that volumetric response (HR: 3.467; p = 0.002) was a significant factor affecting the overall survival in patients with liver metastases of colorectal cancer.@*CONCLUSION@#Volumetric assessment of liver metastases could be an alternative predictor of the overall survival of patients with liver metastases of colorectal cancer treated with a targeted agent.
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PURPOSE@#The purpose of this study was to investigate whether early CT scans are useful for improving the clinical management of acute biliary pancreatitis.@*MATERIALS AND METHODS@#We retrospectively reviewed 56 consecutive patients who experienced first attack of acute pancreatitis and underwent CT scans within 48 hours of symptom onset in the emergency department, between March 2015 and March 2016. CT images were retrospectively evaluated for absence or presence, and etiology of acute pancreatitis, and probability of biliary pancreatitis. Urgent procedures for acute pancreatitis were analyzed.@*RESULTS@#Of 56 patients, 54 (96.4%) showed acute pancreatitis and 23 (41.1%) had biliary pancreatitis on CT. The diagnostic accuracy, sensitivity, and specificity of CT-diagnosed biliary pancreatitis were 94.6% (53/56), 91.7% (22/24), and 96.9% (31/32), respectively. Of the 56 patients, 17 (30.4%) patients with biliary pancreatitis underwent urgent endoscopic retrograde cholangiopancreatography (ERCP) within 72 hours (mean time interval between CT and ERCP: 25.5 ± 19.8 hours; range: 2–67 hours). There was a significant difference in the urgent procedures between non-biliary and biliary pancreatitis groups (0 of 32 vs. 17 of 24, p < 0.001).@*CONCLUSION@#Early CT may be used in patients visiting hospital with suspected acute biliary pancreatitis to facilitate urgent treatment.
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Intramural hematoma of the gastrointestinal tract is a rare disease entity. Pancreatitis-induced intramural gastric hematoma (IGH) is far more seldom reported. Here, we report a rare case of a giant IGH occurring as a delayed complication of pancreatitis in a 51-year-old man. The diagnosis was made using computed tomography (CT) and endoscopic ultrasonography. The patient was conservatively managed, and follow-up abdominal CT showed marked decreases in the size of the IGH.
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A primary benign schwannoma of the liver is extremely rare. Only 30 cases have been reported in the medical literature worldwide, and only one case has been reported in Korea previously. A 56-year-old man was admitted to Gil Medical Center with incidental findings of a hepatic mass by abdominal computed tomography. The computed tomography and magnetic resonance image revealed a 3×2 cm-sized solid mass in the left lobe of the liver. Histological examination confirmed the diagnosis of a benign schwannoma, proven by positive immunoreaction with the neurogenic marker S-100 protein and a negative response to CD34, CD117, and smooth muscle actin. We report a primary benign schwannoma of the liver and review the literature.
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Humanos , Pessoa de Meia-Idade , Actinas , Diagnóstico , Achados Incidentais , Coreia (Geográfico) , Fígado , Músculo Liso , Neurilemoma , Neoplasias do Sistema Nervoso Periférico , Proteínas S100RESUMO
No abstract available.
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Humanos , Amputação Cirúrgica , Fígado , Neuroma , Doadores de TecidosRESUMO
Several recent clinical trials reported that intralymphatic immunotherapy (ILIT) for some allergens, such as cat dander and pollen, induce tolerance more rapidly than conventional subcutaneous or sublingual immunotherapy, have a comparable duration of effect after only 3 injections, and do not provoke serious local or systemic reactions. However, the efficacy and safety of ILIT are using Dermatophagoides farinae (Df), Dermatophagoides pteronyssinus (Dp), and dog, which are indoor allergens that are commonly found globally, need to be evaluated. Furthermore, use of multiple allergens in ILIT should be investigated. We assessed the clinical efficacy and adverse effects of ILIT using aqueous Df, Dp, dog, and cat allergens or mixtures thereof in patients with allergic rhinitis. A total of 11 subjects with AR sensitized to Df, Dp, cat, and/or dog allergens received 3 intralymphatic inguinal injections of sensitized allergen extract (HollisterStier, New Orleans, LA, USA). Clinical parameters were assessed before ILIT, and 4 months and 1 year after the first injection. Rhinitis symptoms were alleviated and quality of life was improved 4 months after ILIT (P=0.012 and P=0.007, respectively), and these improvements lasted for 1 year after ILIT (P=0.047 and P=0.009, respectively). However, we observed 2 cases of anaphylaxis, one case of a moderate-to-severe systemic hypersensitivity reaction and the other case of a severe local reaction at the injection site after ILIT. In conclusion, ILIT can rapidly improve allergy symptoms and quality of life, and this effect lasts for 1 year. In hypersensitized patients, however, ILIT can provoke severe systemic and/or local hypersensitivity reactions when performed using aqueous allergen extracts.
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Animais , Gatos , Cães , Humanos , Alérgenos , Anafilaxia , Alérgenos Animais , Dermatophagoides farinae , Dermatophagoides pteronyssinus , Poeira , Hipersensibilidade , Imunoterapia , Projetos Piloto , Pólen , Pyroglyphidae , Qualidade de Vida , Rinite , Rinite Alérgica , Imunoterapia Sublingual , Resultado do TratamentoRESUMO
PURPOSE: The aim of this study was to verify prognostic factors including sarcopenia in patients with recurrent or metastatic pancreatic cancer receiving gemcitabine-based chemotherapy. MATERIALS AND METHODS: Medical records and computed tomography scan of consecutive patients treated with palliative gemcitabine-based chemotherapy from 2008 to 2014 were reviewed. The lumbar skeletal muscle index at third lumbar spine level was computed, and together with clinicolaboratory factors, univariate and multivariable analyses for overall survival (OS) were performed. RESULTS: A total of 88 patients were found. Median age was 65 years, and male patients were predominant (67.0%). Most patients had initially metastatic disease (72.7%), and gemcitabine monotherapy was administered in 29 patients (33.0%) while gemcitabine plus erlotinib was administered in 59 patients (67.0%). Seventy-six patients (86.3%) had sarcopenia. With a median follow-up period of 44.3 months (range, 0.6 to 44.3 months), median OS was 5.35 months (95% confidence interval [CI], 4.11 to 6.59). In univariate and multivariable analysis, high carcinoembryonic antigen level (hazard ratio [HR], 4.18; 95% CI, 1.95 to 8.97; p < 0.001), initially metastatic disease (HR, 3.37; 95% CI, 1.55 to 7.32; p=0.002), sarcopenia (HR, 2.97; 95% CI, 1.20 to 7.36; p=0.019), neutrophilia (HR, 2.94; 95% CI, 1.27 to 6.79; p=0.012), and high lactate dehydrogenase level (HR, 1.96; 95% CI, 1.07 to 3.58; p=0.029) were identified as independent prognostic factors for OS. CONCLUSION: Five independent prognostic factors in patients with recurrent or metastatic pancreatic cancer who received gemcitabine-based chemotherapy were identified. These findings may be helpful in prediction of prognosis in clinical practice and can be used as a stratification factor for clinical trials.