Assessment of hepatic functional reserve in cirrhotic patients by computed tomography of the caudate lobe.

In order to investigate whether the size of the caudate lobe of the cirrhotic liver is related to the hepatic functional reserve, the morphometric analysis of the caudate lobe was preformed retrospectively using computed tomography in 106 consecutive patients of whom 67 had compensated (group 1), and 39 uncompensated (group 2) liver cirrhosis. In 51 patients, hepatic measurements were repeated in follow-up. Age- and gender-matched controls were studied. The size of the caudate lobe and the ratio of the caudate to right lobe were correlated with liver function. The caudate lobe was larger in the study patients than in the controls, and larger in group 1 than in group 2 (P<0.01). The caudate to right lobe ratios were also greater in the study patients especially in group 1 (P<0.01). In follow-up, the regression coefficient for the caudate to right lobe ratio was positive in group 1 and negative in group 2 (P<0.05). Even though the caudate lobe of patients with uncompensated liver cirrhosis was larger than that of the controls, patients with compensated liver cirrhosis had a larger caudate lobe and higher caudate to right lobe ratio compared to the patients with uncompensated liver cirrhosis. The caudate lobe may have played an important role in maintaining proper liver function in these patients.

Scanning of polypoid gallbladder lesions by ultrasonic microprobes using transpapillary catheterization.

BACKGROUND AND STUDY AIMS: Polypoid lesions of the gallbladder can be diagnosed by transabdominal ultrasonography and endoscopic ultrasonography. However, the image resolution is limited, and the histopathology of these lesions is difficult to determine. We report here on our preliminary results in four patients using a high-frequency (20 MHz) ultrasonic microprobe introduced into the gallbladder via the transpapillary approach. PATIENTS AND METHODS: Insertion of the microprobe into the gallbladder through the papilla of Vater was attempted in four patients with gallbladder diseases without preceding endoscopic sphincterotomy. RESULTS: The lesions in the gallbladder were clearly visualized in three of the four patients. We tried to correlate the characteristic ultrasound findings with the histopathology of the lesions, which were found to be early cancer, adenoma, and adenomyomatosis on histopathology of the specimens after cholecystectomy. No complications occurred. CONCLUSIONS: High-resolution endoscopic transpapillary ultrasonography of the gallbladder is feasible and safe, and may contribute to the diagnosis of gallbladder diseases, particularly of small polypoid lesions.