Quantitative computed tomography of spine: comparison of three-dimensional and two-dimensional imaging approaches in clinical practice.

Quantitative computed tomography (QCT), a widely utilized technique for determining bone mineral density (BMD) at various skeletal sites, may yield less precise measurements if there are operator measurement errors and other technical variables. Two-dimensional (2D)and three-dimensional (3D)QCT scans of the lumbar spine of 21 women were compared in order to investigate the effects of potential operator variability on the precision of BMD measurements and to examine resulting differences of these imaging approaches in clinical practice. No significant difference was found (p > 0.05) in precision between the 2D and 3D QCT BMD measurements owing to operator measurement errors on the CT scans. The variability in BMD values within numerous small regions of interest (ROIs)( approximately 75 mm (2) ) of cancellous bone within a single vertebra was 10.1%, larger than the 2D or 3D BMD variability measured in typical regions ( approximately 250 mm (2)) by an order of magnitude. 3D BMD values in this population, which represented a wide range of clinical values, were found to be significantly greater than 2D BMD values by an average of 5.6% (p = 0.00024) relative to the 2D QCT values. Our findings suggest technical measurement error does not have a significant effect on precision of BMD measurements obtained with either QCT method. Several factors, however, including the incorporation of focal regions of higher density bone mass within the 3D QCT ROI may account for the higher BMD values compared with those for 2D QCT.

Delayed hepatic resection for ruptured hepatocellular carcinoma.

BACKGROUND: Although transcatheter arterial embolization is advocated as initial therapy for ruptured hepatocellular carcinoma (HCC), hepatic resection is necessary for cure. The effectiveness of delayed hepatic resection for ruptured HCC was determined. METHODS: The records of 10 patients who underwent delayed hepatic resection for ruptured HCC were reviewed. RESULTS: All patients were men, and the mean age was 63 years. For hemostasis, transcatheter arterial embolization was performed in three patients, whereas in the other patients bleeding stopped without special procedures. Mean interval from rupture to hepatic resection was 74 days. Liver function test results before hepatic resection were almost normal. Trisegmentectomy in one and bisegmentectomy in four patients were performed, whereas minor hepatic resection was performed for four extrahepatic HCCs. There were no operative or hospital deaths. Four patients had cirrhosis. The mean tumor diameter was 7.5 cm. Of seven patients with recurrence, two with dissemination had tumors that ruptured on the inferior aspect of the liver. The 1- and 3-year survival rates were 77% and 48%, respectively. CONCLUSIONS: Because delayed hepatic resection for ruptured HCC was safe and compared similarly with that for other patients who underwent resection for HCC, it should be used. However, when HCC ruptures in an inferior location, recurrence of tumor as dissemination is likely.

Clinical courses and treatment of splenic artery aneurysms--report of 3 cases and review of literatures in Japan.

We have treated three cases of splenic artery aneurysms recently, so we reported them with a review of 181 cases in Japan. All three cases are women and have characteristic clinical courses and pathogenesis in each to which we performed a reasonable operation so that they could be saved. First one is a ruptured case. So we performed ligation of the splenic artery from inside the aneurysm under 9 min.'s clamp of the aorta. Second one was pointed out the splenic artery aneurysm during admission for cholecystectomy, so we performed splenectomy and aneurysmectomy, and after that we reconstructed the splenic artery with end-to-end anastomosis. Third one suffered from splenomegaly and portal hypertension. We performed splenectomy with the aneurysm. From the clinical and pathological findings, we concluded that an aneurysm in our first case was associated with arterial dysplasia, second with hemodynamic changes in parous women, and third with portal hypertension. Aneurysms of the splenic artery have been rarely reported until recently, when developments in diagnostic procedures made their discovery easier. We have diagnosed splenic artery aneurysm in three patients preoperatively. The clinical symptoms and operative procedure was different in each case, and are reported here. We demonstrated the summary of our three cases of that at Table 1.