Novel methods for clinical risk stratification in patients with colorectal liver metastases.

PURPOSE: Colorectal cancer patients with liver-confined metastases are classified as stage IV, but their prognoses can differ from metastases at other sites. In this study, we suggest a novel method for risk stratification using clinically effective factors. MATERIALS AND METHODS: Data on 566 consecutive patients with colorectal liver metastasis (CLM) between 1989 and 2010 were analyzed. This analysis was based on principal component analysis (PCA). RESULTS: The survival rate was affected by carcinoembryonic antigen (CEA) level (p < 0.001; risk ratio, 1.90), distribution of liver metastasis (p=0.014; risk ratio, 1.46), and disease-free interval (DFI; p < 0.001; risk ratio, 1.98). When patients were divided into three groups according to PCA score using significantly affected factors, they showed significantly different survival patterns (p < 0.001). CONCLUSION: The PCA scoring system based on CEA level, distribution of liver metastasis, and DFI may be useful for preoperatively determining prognoses in order to assist in clinical decisionmaking and designing future clinical trials for CLM treatment.

Metastasis versus focal eosinophilic infiltration of the liver in patients with extrahepatic abdominal cancer: an evaluation with gadobenate dimeglumine-enhanced magnetic resonance imaging.

PURPOSE: To determine the performance of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) to differentiate focal eosinophilic infiltration (FEI) from metastasis. MATERIALS AND METHODS: Gadobenate dimeglumine-enhanced MRI conducted in 38 patients (lesions of 43 metastases and 33 FEIs) with extrahepatic abdominal carcinoma were reviewed retrospectively. Images were divided into 2 sets. Set 1 was composed of precontrast MRI with dynamic phase images. Set 2 included hepatobiliary phase images in addition to the images of set 1. Two blinded radiologists independently categorized each set of images into 5 grades to differentiate metastases from FEI. The area under the receiver operating characteristic curve (Az) was calculated for each set of images. The observers evaluated the shape, signal intensity (SI), and enhancement pattern of the lesions in consensus. RESULTS: The Az values for set 2 images (reader 1: 0.976, and reader 2: 0.743) were greater than those of set 1 (0.961 and 0.709), without statistical significance (P = 0.470 and 0.223). Target appearance was seen in 27 of 43 (63%) metastases on hepatobiliary phase imaging, but none on the FEI. Twenty-five (76%) of the 33 FEIs showed intermingled hypo-SI and iso-SI on hepatobiliary phase images with changing size and shape compared to the T2-weighted images, whereas none of the metastases did. CONCLUSION: Gadobenate dimeglumine-enhanced MRI may assist in the differentiation of FEI from metastasis by highlighting the distinctive features between them, even without hepatobiliary phase imaging.

Reliability and validity of the Korean version of Obsessive-Compulsive Inventory-Revised in a non-clinical sample.

PURPOSE: The reliability and validity of a Korean version of the Obsessive-Compulsive-Inventory-Revised (OCI-R) was examined in non-clinical student samples. MATERIALS AND METHODS: The Korean version of OCI-R was administered to a total of 228 Korean college students. The Maudsley Obsessive Compulsive Inventory (MOCI), Beck's Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI) were administered to 228 students. RESULTS: The total and each of subscale of the Korean OCI-R demonstrated excellent internal consistency, good test-retest reliability, moderate convergent validity and good divergent validity. CONCLUSION: It was concluded that the Korean version of the OCI-R has strong psychometric properties as the original version.

Radiological and clinical features of sarcomatoid hepatocellular carcinoma in 11 cases.

OBJECTIVE: To evaluate the imaging and clinical findings of pathologically proven sarcomatoid hepatocellular carcinoma (HCC) in 11 cases. METHODS: We retrospectively reviewed the imaging findings and clinical features of 11 patients with pathologically proven sarcomatoid HCC at 2 university-based tertiary institutions from July 1997 to June 2006. RESULTS: The most common gross morphologies of sarcomatoid HCC were massive expanding pattern (n = 6 [54%]) or multinodular confluent (n = 5 [46%]) with partial encapsulation (n = 9 [82%]). The most common enhancement pattern was peripheral enhancement with central necrosis (n = 8 [72%]) without a dominant dynamic pattern of enhancement. Six (54%) of 11 patients were positive for hepatitis B surface antigen or hepatitis C virus antibody. Only 1 patient (9%) had more than 500 ng/mL of preoperative serum alpha-fetoprotein. CONCLUSIONS: In a patient with low-level alpha-fetoprotein and no history of viral hepatitis, sarcomatoid HCC usually presents as a large mass with peripheral enhancement, central necrosis, variable enhancement of the solid portion with or without tumor capsule, and intrahepatic metastasis.

Comparison of CT and MRI for presurgical characterization of paraaortic lymph nodes in patients with pancreatico-biliary carcinoma.

AIM: To determine the accuracy of computed tomography (CT) and magnetic resonance (MR) for presurgical characterization of paraaortic lymph nodes in patients with pancreatico-biliary carcinoma. METHODS: Two radiologists independently evaluated CT and MR imaging of 31 patients who had undergone lymphadenectomy (9 metastatic and 22 non-metastatic paraaortic nodes). Receiver operating characteristic (ROC) curve analysis was performed using a five point scale to compare CT with MRI. To re-define the morphologic features of metastatic nodes, we evaluated CT scans from 70 patients with 23 metastatic paraaortic nodes and 47 non-metastatic ones. The short axis diameter, ratio of the short to long axis, shape, and presence of necrosis were compared between metastatic and non-metastatic nodes by independent samples t-test and Fisher's exact test. P < 0.05 was considered statistically significant. RESULTS: The mean area under the ROC curve for CT (0.732 and 0.646, respectively) was slightly higher than that for MRI (0.725 and 0.598, respectively) without statistical significance (P = 0.940 and 0.716, respectively). The short axis diameter of the metastatic lymph nodes (mean = 9.2 mm) was significantly larger than that of non-metastatic ones (mean = 5.17 mm, P < 0.05). Metastatic nodes had more irregular margins (44.4%) and central necrosis (22.2%) than non-metastatic ones (9% and 0%, respectively), with statistical significance (P < 0.05). CONCLUSION: The accuracy of CT scan for the characterization of paraaortic nodes is not different from that of MRI. A short axis-diameter (> 5.3 mm), irregular margin, and presence of central necrosis are the suggestive morphologic features of metastatic paraaortic nodes.

Gallstone spillage caused by spontaneously perforated hemorrhagic cholecystitis.

There are occasional incidences of gallstone spillage during laparoscopic cholecystectomy, and there have been frequent reports on such a topic in the literature. To the best of our knowledge, however, there have been no reports about spilled stones caused by spontaneously perforated hemorrhagic cholecystitis. Here, we report the radiologic findings of spilled stones caused by spontaneously perforated hemorrhagic cholecystitis in a 55-year-old man.

Focal eosinophilic necrosis versus metastasis in the liver: the usefulness of two-phase dynamic CT.

OBJECTIVE: The purpose of our study was to evaluate the usefulness of dual-phase dynamic CT in the differentiation of focal eosinophilic necrosis of the liver and metastasis. CONCLUSION: Undetected isoattenuating lesions on arterial phase images that have an indistinct margin, a nonspherical shape, and a homogenous enhancement pattern on portal venous phase images suggest focal eosinophilic necrosis rather than metastasis. Two-phase dynamic CT was found to be useful at differentiating focal eosinophilic necrosis from metastasis.

Early biliary complications of laparoscopic cholecystectomy: evaluation on T2-weighted MR cholangiography in conjunction with mangafodipir trisodium-enhanced 3D T1-weighted MR cholangiography.

OBJECTIVE: Our aim was to assess preliminary experience with combined conventional T2-weighted and mangafodipir trisodium (MnDPDP)-enhanced T1-weighted MR cholangiography in evaluating early biliary complications of laparoscopic cholecystectomy. SUBJECTS AND METHODS: Conventional heavily T2-weighted MR cholangiography with MnDPDP-enhanced T1-weighted MR cholangiography and ERCP were performed in seven patients with high clinical suspicion of biliary complications after laparoscopic cholecystectomy. The final diagnoses of complications were classified according to the presence and degree of bile duct injury, bile leakage, and retained stones. RESULTS: The diagnoses on MR cholangiography were as follows: complete transection and occlusion of the common bile duct with bile leakage (n = 3), partial strictures of the common bile duct with bile leakage (n = 1), cystic duct leakage (n = 1), partial ligation of an aberrant right hepatic duct (n = 1), and hemorrhage without biliary complication (n = 1). The final diagnoses at surgery (n = 2) and ERCP (n = 5) were as follows: complete transection and occlusion of the common bile duct with bile leakage (n = 2), partial strictures of the common bile duct with bile leakage (n = 2), cystic duct leakage (n = 1), partial ligation of an aberrant right hepatic duct (n = 1), and hemorrhage without biliary complication (n = 1). MR cholangiography accurately yielded the same findings as the final diagnoses, except in one case with partial stricture of the bile duct with bile leakage (overdiagnosed as complete occlusion on MR cholangiography). CONCLUSION: Combined conventional T2-weighted and MnDPDP-enhanced T1-weighted MR cholangiography may eliminate the use of other studies for the imaging of biliary complications after cholecystectomy if this preliminary data can be verified in a larger study.