Preoperative concurrent chemoradiotherapy MRI characteristics favouring pathologic complete response in patients with rectal cancer: Usefulness of MR T2-stage as an ancillary finding for predicting pathologic complete response.

INTRODUCTION: This study sought to assess preoperative concurrent chemoradiotherapy (CRT) magnetic resonance imaging (MRI)-based findings according to a structured MRI report template for primary staging of rectal cancer, and to evaluate the prognostic relevance of the pre-CRT MRI-based findings in patients with rectal cancer after CRT. METHODS: We retrospectively evaluated pre- and post-CRT MRI data of patients with pathologically proven rectal adenocarcinoma, between January 2008 and October 2019. Image interpretation was performed independently by two radiologists and each reviewer assessed the cancer characteristics on MRI, based on the structured MRI report for primary staging. MRI-based findings associated with pathologic complete tumour regression grade (TRG) after CRT were analysed by univariate and multivariate analysis. Significant factors from pre-CRT MRI were weighted to score mrTRG in post-CRT MRI. RESULTS: On univariate analysis, MR T-stage, tumour infiltration, mesorectal fascia involvement, extramural vascular invasion and serum carcinoembryonic antigen level correlated significantly with pathologic complete response (pCR). Multivariate analysis identified that only MR T-stage was independently associated with pCR (odds ratio, 3.89, 95% confidence interval, 1.18-12.84; P = 0.0278). Adding MRI-based T2-stage as an ancillary finding to mrTRG statistically significantly improved the sensitivity as compared to using only mrTRG for considering a CR. T2_mrTRG was significantly different in terms of the time to tumour progression between the CR and non-CR group. CONCLUSIONS: The MR T2-stage was independently associated with pCR after CRT in patients with rectal cancer and was helpful as ancillary predictive factor, adding to mrTRG for prediction of pCR.

Effectiveness of percutaneous lumbar foraminoplasty in patients with lumbar foraminal spinal stenosis accompanying redundant nerve root syndrome: A retrospective observational study.

The clinical outcomes of redundant nerve root syndrome (RNRS) in patients with lumbar foraminal spinal stenosis (LFSS) are currently unknown. The purpose of this study was to evaluate the postprocedural outcomes of RNRS in LFSS after percutaneous lumbar foraminoplasty (PLF) and identify the factors associated with RNRS by comparative analysis between patients with and without RNRS.Patients with LFSS who underwent PLF were retrospectively analyzed. RNRS is defined as the presence of thick, elongated, and tortuous structures in the cauda equine associated with lumbar spinal stenosis. Based on the sagittal or transverse magnetic resonance imaging scans obtained before the PLF, the patients were stratified into 2 groups. Comparative analysis was performed between patients with RNRS (group R) and those without RNRS (group C).From March 2016 to January 2019, 8 of the 21 (38.1%) patients undergoing PLF showed signs of RNRS on magnetic resonance imaging images. PLF showed a tendency for less therapeutic effect with respect to changes in pain intensity in group R as compared to group C, but there were no statistically significant differences between the 2 groups. RNRS correlated with the cross-sectional area (CSA) of the dural sac and LFSS grade (P < .05). The CSA of the dural sac was smaller and the grade of LFSS was higher in group R than in group C.RNRS is commonly associated with lumbar spinal stenosis and could affect the treatment outcomes. Clinical outcomes in group R were not statistically different from those in group C, although group R showed slightly worse outcomes. The independent factors associated with RNRS were CSA of the dural sac and the LFSS grade.

Chronic inflammation-related radiological findings of gallbladder adenomyomatosis.

PURPOSE: This study aimed to assess radiological findings of adenomyomatosis advancing to chronic inflammation to differentiate between adenomyomatosis with and without chronic inflammation. MATERIALS AND METHODS: We retrospectively identified 79 patients with pathologically proven adenomyomatosis without (n = 10) or with chronic inflammation (n = 69), who underwent computed tomography (CT) and magnetic resonance imaging (MRI) followed by surgery. MRI analysis included evaluation of GB wall-thickening type, presence and location of intramural cysts, and presence of stones. CT analysis included GB wall-thickening type only. Multivariate logistic regression analysis was used to identify the image-based findings of adenomyomatosis associated with chronic inflammation. RESULTS: On univariate analysis, MRI-based GB wall-thickening type and presence of stones, and CT-based GB wall-thickening type were significantly different between adenomyomatosis with and without chronic inflammation. On multivariate analysis, only the absence of stones was identified as a significant predictor of adenomyomatosis without chronic inflammation (odds ratio 5.58; 95% confidence interval 1.20-26.01; p = 0.029). There was no significant difference in other MRI- and CT-based findings between adenomyomatosis with and without chronic inflammation. CONCLUSION: In patients with adenomyomatosis, the presence of stones was independently associated with chronic inflammation.

Usefulness of histologic differences and perivascular infiltration for preoperative T staging of advanced gastric cancer using computed tomography.

PURPOSE: This study aimed to determine whether histologic differences and perivascular infiltration are useful for clinical T staging of advanced gastric cancer (AGC). MATERIALS AND METHODS: This retrospective study included 160 patients with pathologically confirmed AGC who had available preoperative stomach computed tomography (CT). Using stomach CT, they were classified according to standard T stage, histologic T stage, and perivascular T stage. Accuracy of each T stage criteria was analyzed. Perivascular infiltrations for the evaluation of prognosis were correlated with time to tumor progression by log-rank test. RESULTS: There was a significant difference between the accuracies of the standard and histologic T stages (p < 0.001), whereas there was no significant difference between the standard and perivascular T stages (p = 0.07). In 121 patients who were pathologically confirmed as having T3 or T4a tumor, there was a significant difference between the standard and perivascular T stage (p < 0.001). In patients having T3 or T4a tumor, time to tumor progression of the negative perivascular infiltration subgroup was significantly longer than the positive subgroup. CONCLUSION: Consideration of histologic differences and perivascular infiltration may be useful for clinical T staging of AGC.

Effects of nicardipine on the onset time and intubation conditions of rocuronium-induced neuromuscular blockade.

STUDY OBJECTIVE: The objective of this study was to identify the effects of nicardipine on neuromuscular blockade of rocuronium, such as the onset time and intubation conditions, using a nicardipine dose that attenuates cardiovascular responses during endotracheal intubation. DESIGN: Randomized, double-blinded, placebo-controlled clinical comparison was used as the design of this study SETTING: The study was conducted at the operating room of a university hospital. PATIENTS: Participants of this study comprise 78 American Society of Anesthesiologists physical status 1 and 2 patients, aged 18 to 60 years who were undergoing elective surgery under general anesthesia. INTERVENTIONS: The nicardipine group was given an intravenous bolus of 20 µg/kg nicardipine before tracheal intubation: the control group was given an intravenous bolus of a comparable volume of normal saline before tracheal intubation. MEASUREMENTS: Using a TOF-Watch SX monitor, the time from the end of the injection of rocuronium to maximum depression of T1 (onset time) was measured. Intubation was performed 1 minute after rocuronium administration, and the status of the intubation conditions was assessed. The mean blood pressure and heart rate were each measured after endotracheal intubation. Rate pressure product values were also calculated. MAIN RESULTS: Intubation conditions were clinically acceptable in 37 (94.9%) of 39 patients in group N compared with 29 (74.4%) of 39 in group C (P < .05). The onset time of rocuronium was significantly faster in group N than in group C (P < .05). The mean blood pressure was significantly lower in group N than in group C (P < .05). The heart rate was significantly higher in group N than in group C (P < .05). Rate pressure product values showed no significant difference between the two groups (P > .05). CONCLUSIONS: Pretreatment with 20 µg/kg nicardipine improves intubation conditions, shortens the onset time of rocuronium, and attenuates cardiovascular responses to tracheal intubation.

Epithelioid hemangioendotheliomas with TFE3 gene translocations are compossible with CAMTA1 gene rearrangements.

Epithelioid hemangioendotheliomas (EHEs) are vascular tumors of intermediate malignancy that can undergo high-grade malignant transformations. EHEs have been characterized by tumor-specific WW domain-containing transcription regulator 1(WWTR1)-calmodulin-binding transcription activator 1 (CAMTA1) translocations, and recently, a novel Yes-associated protein 1 (YAP1)-transcription factor E3 (TFE3) gene fusion was identified in EHEs. In this study, we examined the expression levels of TFE3 and CAMTA1 via immunohistochemical staining and identified chromosomal alterations using fluorescence in situ hybridization (FISH) assays and RT-PCR tests. Although all of the EHEs were CAMTA1-positive in immunohistochemical staining, only five out of 18 EHEs (27.78%) positively expressed nuclear TFE3. The five TFE3-positive EHEs exhibited TFE3 gene break-apart in FISH assays. YAP1-TFE3 gene fusions were confirmed by RT-PCR. Interestingly, we observed CAMTA1 gene break-apart in all of the five TFE3-positive EHEs via FISH assays, and four out of the five TFE3-positive EHEs exhibited WWTR1-CAMTA1 gene fusions via RT-PCR. These results indicate that these two chromosomal alterations are not mutually exclusive but compossible in EHEs. Finally, primary tumor sites in TFE3-positive EHEs consistently contained single masses (P = 0.0359) with larger sizes (P = 0.0550) compared to TFE3-negative EHEs. Similar to previous reports, we observed well-formed vessels more frequently in TFE3-positive EHEs than in TFE3-negative EHEs (P = 0.0441). In addition, TFE3-positive EHEs tended to more frequently demonstrate high-grade nuclear atypia (P = 0.0654) and hypercellularity (P=0.0987) than TFE3-negative EHEs. Thus, we have now established two clinically distinct subgroups of EHEs: TFE3-positive and TFE3-negative EHEs.

Impact of Bowel Preparation Quality on Adenoma Identification During Colonoscopy and Optimal Timing of Surveillance.

BACKGROUND: All present guidelines regarding surveillance intervals after index colonoscopy are based on optimal bowel preparation. However, the appropriate timing of repeat colonoscopy after suboptimal bowel preparation is not clear. AIMS: To determine the appropriate timing of repeat colonoscopy following index colonoscopy with suboptimal bowel preparation. METHODS: The medical records of patients who underwent colonoscopy over 5 years were retrospectively analyzed. Index colonoscopy was defined as the first colonoscopy in patients who underwent the procedure at least twice during the study period. Bowel preparation quality was classified as optimal, fair, or poor. RESULTS: The overall adenoma detection rate was 39.1% (95% confidence interval [CI], 38.0-40.1%), but the detection rate depended significantly on bowel preparation quality (p < 0.001). The adenoma miss rate (AMR) was significant after poor (69.6%) than after optimal (27.3%) and fair (48.1%) preparation (p < 0.001). At surveillance intervals ≤2 years, the odds ratio (OR) for AMR was significantly higher for poor (OR 6.25; 95% CI, 3.76-11.83) and fair (OR 3.67; 95% CI, 2.19-6.16) preparation relative to optimal preparation; however, no difference was observed at surveillance intervals >2 years. CONCLUSIONS: Bowel preparation quality significantly affects AMR. Colonoscopy should be repeated within 2 years in patients with suboptimal bowel preparation at index colonoscopy.

Comparison of etomidate and propofol on intubating conditions and the onset time associated with cisatracurium administration.

BACKGROUND: This study compared intubating conditions and the onset time associated with administration of cisatracurium, a nondepolarizing neuromuscular blocker with a relatively slow onset, according to prior injection of one of two intravenous anesthetic agents: propofol or etomidate. METHODS: Forty-six female patients, undergoing general anesthesia and endotracheal intubation for elective surgery, were randomized to two groups; group P were administered propofol (2 mg/kg) prior to cisatracurium (0.2 mg/kg); group E were administered etomidate (0.3 mg/kg) prior to cisatracurium (0.2 mg/kg). We measured intubating conditions and the onset time according to the types of intravenous anesthetic administered. Measurements of heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were taken immediately prior to induction; immediately and 1 min after IV anesthetic administration; and immediately and 1, 2, 3, 4, 5, 7, and 15 min after endotracheal intubation. RESULTS: Intubating conditions were superior in group E compared with group P (P = 0.009). The average onset time of cisatracurium was more rapid in group E (155.74 ± 32.92 s vs. 185.26 ± 38.57 s in group P; P = 0.008). There were no group differences in SBP, DBP, and HR following intravenous anesthetic drug injection and endotracheal intubation. However, SBP and DBP were substantially higher in group E after endotracheal intubation. CONCLUSIONS: Etomidate improves intubating conditions and provide a more rapid onset time of cisatracurium during anesthetic induction compared to propofol.

Added value of arterial enhancement fraction color maps for the characterization of small hepatic low-attenuating lesions in patients with colorectal cancer.

OBJECTIVE: To assess the added value of arterial enhancement fraction (AEF) color maps for the differentiation of small metastases from hepatic benign lesions. SUBJECTS AND METHODS: We retrospectively analyzed 46 patients with colorectal cancer who underwent multiphasic liver CT imaging and had low-attenuating liver lesions smaller than 3 cm (123 total lesions; metastasis: benign = 32:91). AEF color maps of the liver were created from multiphasic liver CT images using dedicated software. Two radiologists independently reviewed multiphasic CT image sets alone and in combination with image sets with AEF color maps using a five-point scale. The additional diagnostic value of the color maps was assessed by means of receiver-operating characteristic (ROC) analysis. RESULTS: The area under the ROC curve (Az) increased when multiphasic CT images were combined with AEF color map analysis as compared with evaluation based only on multiphasic CT images (from 0.698 to 0.897 for reader 1, and from 0.825 to 0.945 for reader 2; P < 0.001 and 0.002, respectively). The increase Az was especially significant for lesions less than 1 cm (from 0.702 to 0.888 for reader 1, and from 0.768 to 0.958 for reader 2; P = 0.001 and P = 0.001, respectively). The mean AEF of tumor-adjacent parenchyma (35.07 ± 27.2) was significantly higher than that of tumor-free liver parenchyma (27.3 ± 20.6) (P = 0.04). CONCLUSIONS: AEF color mapping can improve the diagnostic performance for small hepatic metastases from colorectal cancer and may allow for the elimination of additional examinations.

CT differentiation of 1-2-cm gallbladder polyps: benign vs malignant.

PURPOSE: To evaluate MDCT findings of 1-2-cm sized gallbladder (GB) polyps for differentiation between benign and malignant polyps. METHODS: Institutional review board approval was obtained, and informed consent was waived. Portal venous phase CT scans of 1-2-cm sized GB polyps caused by various pathologic conditions were retrospectively reviewed by two blinded observers. Among the 36 patients identified, 21 had benign polyps with the remaining 15 having malignant polyps. Size, margin, and shape of GB polyps were evaluated. Attenuation values of the polyps, including mean attenuation, maximum attenuation, and standard deviation, were recorded. As determined by visual inspection, the degree of polyp enhancement was evaluated. Using these CT findings, each of the two radiologists assessed and recorded individual diagnostic confidence for differentiating benign versus malignant polyps on a 5-point scale. The diagnostic performance of CT was evaluated using a receiver operating characteristic curve analysis. RESULTS: There was no significant difference in size between benign and malignant GB polyps. Ill-defined margin and sessile morphology were significantly associated with malignant polyp. There was a significant difference in mean and maximum attenuation values between benign and malignant GB polyps. Mean standard deviation value of malignant polyps was significantly higher than that of benign polyps. All malignant polyps showed either hyperenhancement or marked hyperenhancement. A z value for the diagnosis of malignant GB polyps was 0.905. CONCLUSION: Margin, shape, and enhancement degree are helpful in differentiating between benign and malignant polyps of 1-2-cm sizes.

Epithelial wound healing after cataract surgery comparing two different topical fluoroquinolones.

PURPOSE: To compare the epithelial wound healing response of two preservative-free fluoroquinolones, moxifloxacin and levofloxacin, in patients who underwent cataract surgery. MATERIALS AND METHODS: In this prospective, evaluator-masked, randomized clinical trial, 59 eyes of 50 patients who underwent cataract surgery were enrolled. Patients were randomized to receive moxifloxacin 0.5% (n=32 eyes) or levofloxacin 0.5% (n=27 eyes). All patients instilled moxifloxacin or levofloxain four times daily for 1 week prior to surgery and 2 weeks after surgery. The epithelial wound healing status in the corneal incision site was scanned with a raster scan mode of fourier-domain optical coherence tomography (FD-OCT). The number of eyes showing epithelial defect images and average number of corneal epithelial defect cuts per eye were compared between groups. All patients were evaluated on postoperative days 1, 2, 3, and 10. RESULTS: On postoperative days 1, 2, and 3, the number of eyes showing epithelial defects in FD-OCT was not statistically different (all p>0.05). The average number of corneal epithelial defect cuts was also not statistically different between the two groups (all p>0.05). No eyes showed epithelial defects on postoperative day 10 in either group. CONCLUSION: There were no differences on epithelial wound healing comparing these two different fluoroquinolones at the incision site of cataract surgery.

Differential diagnosis of left-sided abdominal pain: primary epiploic appendagitis vs colonic diverticulitis.

AIM: To investigate the clinical characteristics of left primary epiploic appendagitis and to compare them with those of left colonic diverticulitis. METHODS: We retrospectively reviewed the clinical records and radiologic images of the patients who presented with left-sided acute abdominal pain and had computer tomography (CT) performed at the time of presentation showing radiological signs of left primary epiploic appendagitis (PEA) or left acute colonic diverticulitis (ACD) between January 2001 and December 2011. A total of 53 consecutive patients were enrolled and evaluated. We also compared the clinical characteristics, laboratory findings, treatments, and clinical results of left PEA with those of left ACD. RESULTS: Twenty-eight patients and twenty-five patients were diagnosed with symptomatic left PEA and ACD, respectively. The patients with left PEA had focal abdominal tenderness on the left lower quadrant (82.1%). On CT examination, most (89.3%) of the patients with left PEA were found to have an oval fatty mass with a hyperattenuated ring sign. In cases of left ACD, the patients presented with a more diffuse abdominal tenderness throughout the left side (52.0% vs 14.3%; P = 0.003). The patients with left ACD had fever and rebound tenderness more often than those with left PEA (40.0% vs 7.1%, P = 0.004; 52.0% vs 14.3%, P = 0.003, respectively). Laboratory abnormalities such as leukocytosis were also more frequently observed in left ACD (52.0% vs 15.4%, P = 0.006). CONCLUSION: If patients have left-sided localized abdominal pain without associated symptoms or laboratory abnormalities, clinicians should suspect the diagnosis of PEA and consider a CT scan.

Diagnostic role of computed tomographic enterography differentiating crohn disease from intestinal tuberculosis.

OBJECTIVES: The aim of the present study was to evaluate the diagnostic role of computed tomographic enterography (CTE) in distinguishing Crohn disease (CD) from intestinal tuberculosis (ITB). MATERIALS AND METHODS: From January 2006 to August 2011, a total of 81 consecutive patients (64 patients with CD and 17 patients with ITB) who received CTE on the initial workup were included. In CTE, degree of bowel involvement (number and length), mural change (mural hyperenhancement, stratification, wall thickening, and distribution), adjacent mesenteric change (comb sign, fibrofatty proliferation, fistula, abscess, and lymphadenopathy), and peritoneal change (peritoneal thickening and ascites) were assessed. RESULTS: Segmental involvement, comb sign, fibrofatty changes, moderate wall thickening, and asymmetric distribution were significantly more common in the patients with CD than those with ITB. A positive comb sign was the most suggestive finding of CD (sensitivity, 74.1%; specificity, 90.9%). CONCLUSIONS: A positive comb sign is the most suggestive finding that differentiates CD from ITB.

Added value of subtraction imaging in detecting arterial enhancement in small (<3 cm) hepatic nodules on dynamic contrast-enhanced MRI in patients at high risk of hepatocellular carcinoma.

OBJECTIVES: To determine the importance of arterial enhancement in diagnosing small (<3 cm) hepatocellular carcinomas (HCCs) and to evaluate the added value of dynamic subtraction magnetic resonance imaging (MRI) in detecting arterial enhancement in small (<3 cm) hepatic nodules in high-risk patients. METHODS: Eighty-six patients with 135 pathologically confirmed small (<3 cm) hepatic nodules (104 HCCs, 31 benign nodules) underwent MRI before curative surgery. Arterial enhancement was determined by three methods: (1) visual assessment of the arterial phase alone, (2) visual comparison of the arterial phase with the unenhanced phase and (3) additional review of subtraction images. The diagnostic performance of each method was calculated and compared using generalised estimating equations analysis. RESULTS: Arterial enhancement demonstrated high positive predictive value (PPV) (96.5-98.9 %) and specificity (90.3-96.8 %), but low negative predictive value (NPV) (54.6-62.5 %) and intermediate sensitivity (76-79.8 %) for diagnosing small HCCs. Diagnostic performance was highest for subtraction imaging. There were significant differences among the three methods in sensitivity (P = 0.04), accuracy (P = 0.044), PPV (P < 0.001) and NPV (P = 0.024), but not in specificity (P = 0.167). CONCLUSION: The accurate detection of arterial enhancement in small hepatic nodules is important for diagnosing HCC and may be enhanced by subtraction imaging.

Changes of clinical manifestation of granular corneal deposits because of recurrent corneal erosion in granular corneal dystrophy types 1 and 2.

PURPOSE: To elucidate changes of clinical manifestation of granular corneal deposits after recurrent corneal erosion in granular corneal dystrophy types 1 and 2 (GCD1 and GCD2). METHODS: Six patients (5 patients with GCD2 and 1 with GCD1) were included. Slit-lamp photographs of all patients and Fourier domain optical coherence tomography images of 3 available patients were analyzed. In part II of this study, to evaluate deposit disappearance incidence (becoming annular granular deposits), we counted deposits of another 60 GCD2 heterozygotes according to decade of age as the following subgroups: discoid (filled-up) granular deposits, annular (ring-shaped) granular deposits, and lattice-like lesions. RESULTS: Granular deposits dropped off singularly during recurrent corneal erosion in GCD2 heterozygotes, becoming annular deposits. In contrast, confluent granular deposits in GCD2 homozygotes and GCD1 patients dropped off in groups. Reaccumulation was observed at the margin of the previously dropped off area in patients who were followed-up for an extended period. Part II of the study showed that annular deposits appeared in the third decade and increased gradually. Discoid granular deposits increased sharply in the 40s age group, and lattice-like lesions increased gradually from the third decade. CONCLUSIONS: The disappearance of granular deposits in GCD1 and GCD2 could be interpreted as evidence of drop-off phenomena with recurrent corneal erosion. With drop off of the deposits, various configurations and morphological changes of corneal deposits can occur in these corneal dystrophies.

Response evaluation in patients with colorectal liver metastases: RECIST version 1.1 versus modified CT criteria.

OBJECTIVE: Our retrospective study compared Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 with modified CT criteria to determine their respective utilities as a prognostic indicator. Using both sets of criteria, we compared treatment responses of patients with colorectal liver metastases treated with bevacizumab-containing chemotherapy with those of patients treated with chemotherapy alone. MATERIALS AND METHODS: Fifty-nine patients who received bevacizumab-containing chemotherapy (n=30, group 1) or chemotherapy alone (n=29, group 2) for the treatment of colorectal carcinoma underwent contrast-enhanced CT before treatment and 2 months after treatment. Two radiologists determined changes in tumor size and density between the pretreatment and 2-month follow-up CT images. RECIST 1.1 assesses responses on the basis of changes in tumor size, and the modified CT criteria assesses responses on the basis of changes in tumor density and size. Responses were correlated with time to tumor progression by log rank test. RESULTS: According to RECIST 1.1, nine of 30 patients (30%) in group 1 and 12 of 29 patients (41%) in group 2 were good responders. According to the modified CT criteria, 23 of 30 patients in group 1 (77%) and 23 of 29 patients in group 2 (79%) were good responders. As assessed by the modified CT criteria, good responders in both groups had significantly longer time to tumor progression than poor responders (p<0.05). As assessed by RECIST 1.1, good responders in group 1 had significantly longer time to tumor progression than poor responders (p=0.0154), but there was no difference in group 2. CONCLUSION: Evaluating treatment response with tumor size and density changes on CT was a better predictor of time to tumor progression than changes in tumor size alone in both groups.

Enhancement patterns of hepatocellular carcinoma after transarterial chemoembolization using drug-eluting beads on arterial phase CT images: a pilot retrospective study.

OBJECTIVE: The purpose of this article is to assess CT enhancement patterns of hepatocellular carcinoma (HCC) within 1 month after transarterial chemoembolization (TACE) using drug-eluting beads and to determine whether enhancement patterns may be useful for predicting local tumor progression. MATERIALS AND METHODS: Forty-one patients with 50 HCCs underwent CT within 1 month after TACE with drug-eluting beads. Two blinded readers independently reviewed the arterial phase images and classified enhancement patterns as follows: no enhancement, peripheral ring enhancement, and peripheral nodulelike enhancement. Enhancement patterns were correlated with time to tumor progression of enhancing tissue by log-rank test. RESULTS: In the group with no enhancement, 92.3% (24/26) had not progressed and 7.7% (2/26) showed progression; for peripheral ring enhancement, 83.3% (10/12) had not progressed and 16.7% (2/12) showed progression; and for peripheral nodulelike enhancement, 16.7% (2/12) had not progressed and 83.3% (10/12) showed progression. The time to progression of enhancing tissue was significantly different between the group with no enhancement plus peripheral ring enhancement and the group with peripheral nodulelike enhancement (p < 0.001). CONCLUSION: Analysis of enhancement patterns at the arterial phase of the first follow-up CT after TACE with drug-eluting beads is helpful for predicting progression of treated HCC.

Extremely varied phenotypes in granular corneal dystrophy type 2 heterozygotes.

PURPOSE: To investigate the phenotypic variability of patients bearing the heterozygous R124H mutation in the TGFBI (transforming growth factor-beta-induced) gene that causes granular corneal dystrophy type 2 (GCD2). METHODS: We describe the phenotypic range of GCD2 heterozygotes for the common R124H mutation in TGFBI; seven with an extremely mild phenotype and six with an extremely severe phenotype. Detailed slit-lamp photographs of these patients were generated. All patients had no history of ocular surgery and were diagnosed as being heterozygous for GCD2 by DNA analysis from peripheral blood. Expression levels of transforming growth factor-beta-induced protein (TGFBIp) were compared among cultured corneal fibroblasts from ten normal donors. RESULTS: We report profound differences in the severity of the phenotype across our case series. Two patients with a mild phenotype were diagnosed as unaffected at presentation; however follow-up examinations revealed granular deposits. Importantly, we also observed familial clustering of phenotypic variance; five patients from two families with a mild phenotype showed a similarly mild phenotype within family members. Similarly, six patients from two families with severe phenotypes showed corneal deposits with similar patterns and severity within each distinct family, but distinct patterns between families. TGFBIp expressions from different donor derived cultured corneal fibroblasts were different between one another. CONCLUSIONS: GCD2 heterozygotes have extremely varied phenotypes between individual patients. However phenotypes were broadly consistent within families, suggesting that the observed variable expressivity might be regulated by other genetic factors that could influence the abundance of TGFBIp or the function of the pathway. From a clinical perspective, our data also highlighted that genetic analysis and meticulous slit-lamp examination in both eyes at multiple time intervals is necessary.