Perfusion MR imaging with a superparamagnetic iron oxide using T2-weighted and susceptibility-sensitive echoplanar sequences: evaluation of tumor vascularity in hepatocellular carcinoma.

OBJECTIVE: The study purpose was to examine the usefulness of perfusion echoplanar MR imaging with a superparamagnetic iron oxide (SHU-555A) for evaluating the vascularity of hepatocellular carcinomas. SUBJECTS AND METHODS: Twenty-two patients with 32 hepatocellular carcinomas underwent perfusion imaging with bolus injection (0.7-1.1 ml) of SHU-555A. Echoplanar sequences included multishot spin-echo (17 patients) and single-shot gradient-echo (five patients) imaging. Image acquisition was repeated every 30 sec for 3 min with the multishot spin-echo sequence and every 2 sec for 100 sec with the single-shot gradient-echo sequence. Lesion signal intensity versus time curves were created for quantitative analysis. RESULTS: Transient decreases in tumor signal intensity (28.8% with multishot spin-echo and 63.3% with the single-shot gradient-echo) were seen in the perfusion phase. These decreases in signal intensity were statistically significantly (p < .01) different for each histologic type of hepatocellular carcinoma (poorly differentiated, 43.3%; well differentiated, 18.4%; and moderately differentiated, 24.8%). After the perfusion phase, the tumor signal intensities rapidly recovered. The multishot spin-echo sequence could detect some signal changes even in lesions smaller than 1 cm. CONCLUSION: Hepatocellular carcinoma vascularity can be evaluated with perfusion echoplanar imaging with SHU-555A. Because of its excellent temporal resolution, the single-shot gradient-echo echoplanar sequence detects the transient signal decrease in most lesions. The high image quality of the multishot spin-echo echoplanar sequence allows evaluation of the vascularity of even very small lesions.

Mesenteric arterioportal shunt after hepatic artery interruption.

BACKGROUND: Massive hepatic necrosis from hepatic artery (HA) interruption is a complication after extended pancreatobiliary operation. The effectiveness of a mesenteric arterioportal shunt in preventing liver failure after massive hepatic necrosis was evaluated. METHODS: Of 98 patients who underwent pancreatic or hepatic resection for pancreatobiliary carcinoma between January 1989 and December 1995, six received a mesenteric arterioportal shunt. Clinical and hemodynamic analyses were done retrospectively. RESULTS: The six patients were classified into groups: A, postoperative hepatic arterial occlusion and, B, main HA excision without reconstruction. One patient in group A and three patients in group B had good arterioportal shunt patency and favorable clinical courses. However, fatal hepatic necrosis after ligation of the HA proper occurred in one patient in group A from small portal flow despite a presumed patent shunt. In another patient in group A angiogram revealed shunt occlusion. CONCLUSIONS: A mesenteric arterioportal shunt is beneficial when massive hepatic necrosis has occurred or is expected after main HA interruption under such conditions as postoperative hepatic arterial occlusion or HA excision without reconstruction. The procedure has the advantages of appropriate selection of artery size, a lower abdominal site apart from the primary operative field, and easy shunt closure by transarterial embolization.

Plasma adsorption to charcoal and ion-exchange resin for treating postoperative hepatic failure.

Postoperative hepatic failure was treated by plasma adsorption (PA) to charcoal and ion-exchange resin in five patients suffering from pancreatic or biliary carcinoma that was not accompanied by liver cirrhosis. Four of these patients recovered completely from the hepatic failure, while the fifth patient recovered sufficiently to be taken off the treatment for three weeks. Reactions in platelet counts and circulatory system during and after the PA treatment were minimal in all these patients. PA proved to be an effective liver support system for treating non-cirrhotic patients with postoperative hepatic failure.

Partial portal arterialization for the prevention of massive liver necrosis following extended pancreatobiliary surgery: experience of two cases.

Massive liver necrosis, which is a severe and highly fatal complication after extended pancreatobiliary surgery, may occur due to an interruption of the hepatic arterial flow caused by such events as an excision of the hepatic artery invaded by cancer, a ligation of the postoperatively ruptured hepatic artery, or a thrombotic obstruction of the reconstructed hepatic artery. In order to improve this ischemic state of the liver, we have performed a partial arterialization of the portal vein by making an arteriovenous shunt at the mesenteric vascular branches in two cases. Although a sufficient pathophysiological investigation could not be fully conducted, partial portal arterialization was considered to be effective in one patient, while no clinically noticeable adverse effects were revealed in the other patient.

Blood flow pattern of the interatrial communication in patients with complete transposition of the great arteries: a pulsed Doppler echocardiographic study.

We analyzed blood flow pattern in the interatrial communication in 24 patients with complete transposition of the great arteries (TGA). Eight had TGA with atrial shunt (group 1), nine had TGA with patent ductus arteriosus or ventricular septal defect (group 2), and seven had pulmonary arterial banding and Blalock-Taussig shunt (group 3). The flow pattern was determined at the site of atrial septal defect by Doppler echo beam directed as perpendicular to the septum as possible. The flow pattern was composed of a left-to-right (L-R) flow and right-to-left (R-L) flow. The turning point (T1) from the R-L to L-R flow occurred immediately after the initiation of the QRS on the electrocardiogram and was common in all groups. The other turning point (T2) from L-R to R-L occurred after the second heart sound (S2). The S2-T2 interval decreased on inspiration, indicating prolongation of the period of R-L flow. The minimum S2-T2 interval ranged from 20 to 70 (mean +/- SD 50 +/- 18) msec in group 1, from 70 to 130 (114 +/- 25) msec in group 2, and from 50 to 138 (75 +/- 29) msec in group 3. The maximum S2-T2 interval ranged from 48 to 110 (88 +/- 21) msec in group 1, from 140 to 235 (175 +/- 36) msec in group 2, and from 80 to 170 (111 +/- 30) msec in group 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of the drainage site in anomalous pulmonary venous connection by two-dimensional Doppler color flow-mapping echocardiography.

Ten patients with total and one with partial anomalous pulmonary venous connection were studied by two-dimensional Doppler color flow-mapping echocardiography. In cases of anomalous pulmonary venous drainage into the innominate vein through the vertical vein, flow away from the transducer was detected in the echo space behind the atria in the subxiphoid four-chamber approach. In the suprasternal approach, flow toward the transducer was detected at the junction of the vertical and innominate veins. In the case of an anomalous pulmonary vein connecting directly into the superior vena cava, an area of flow toward the transducer, which was triangular in shape, was detected in the dilated superior vena cava. In the two cases in which the pulmonary vein drained into the coronary sinus, the flow toward the transducer was observed at the ostium of the coronary sinus in the subxiphoid four-chamber view, and it appeared as if the blood flow was emerging from this point. In a case of the paracardiac type of total anomalous pulmonary venous connection with drainage into the posterior wall of the right atrium, the flow toward the transducer occurred higher in the right atrium than in the cases with drainage into the coronary sinus. In a case with the infradiaphragmatic type of total anomalous pulmonary venous connection, continuous flow toward the transducer, which passed through the diaphragm in an anomalous vessel, was detected from the subxiphoid area. The downward flow in the anomalous vessel changed to an upward flow at the site of drainage into the hepatic vein.(ABSTRACT TRUNCATED AT 250 WORDS)