Adrenal masses: quantification of fat content with double-echo chemical shift in-phase and opposed-phase FLASH MR images for differentiation of adrenal adenomas.

PURPOSE: To quantify fat content in adrenal lesions with double-echo chemical shift magnetic resonance (MR) imaging in a phantom study and to differentiate adrenal adenomas from other adrenal masses by assessing fat content in a clinical study. MATERIALS AND METHODS: The study consisted of two parts: a phantom study and a clinical study. To explore the effect of the T1 value on in- and opposed-phase MR images of fat-containing tissues, phantom models with various proportions of fat and gadopentetate dimeglumine concentrations were implemented. Signal intensity (SI) indexes ([SI in-phase - SI opposed-phase]/SI in-phase) were calculated with double-echo fast low-angle shot (FLASH) MR imaging. In the clinical study, 23 patients with 28 adrenal masses (16 adrenal adenomas, nine adrenal metastases, and three pheochromocytomas) underwent double-echo FLASH MR imaging, and SI indexes were calculated. RESULTS: SI index reached a maximum of 0.87 at 53% fat fraction for gadopentetate dimeglumine concentration at 0.5 mmol/L as the simulated T1 of the adrenal mass. The SI indexes of the adrenal adenomas, adrenal metastases, and pheochromocytomas, respectively, were 0.36, -0.15, and -0.07, and estimated fat fraction from the phantom study was 26.5%, 0%, and 0%. All adrenal adenomas contained fat on double-echo FLASH images. There was no overlap in SI index between adenomas and other tumors. CONCLUSION: Preliminary experience indicates that quantitative measurement of the fat fraction of adrenal masses is possible with the double-echo chemical shift FLASH technique and allows for differentiating adrenal adenomas from other adrenal masses.

Fast breath-hold T2-weighted MRI of the kidney by means of half-Fourier single-shot turbo spin echo: comparison with high resolution turbo spin echo sequence.

PURPOSE: The value of the fast half-Fourier single-shot turbo spin echo (HASTE) sequence in T2-weighted MRI of the kidney was evaluated as a substitute for the conventional turbo spin echo (TSE) sequence. METHOD: Forty-five patients with suspected abnormalities of the kidney underwent MRI with a 1.5 T system. Breath-hold HASTE and respiratory-triggered TSE sequences were performed. Qualitative and quantitative analyses were performed for comparison of these sequences. RESULTS: The signal-to-noise ratio (SNR) with HASTE was higher than that with TSE. The lesion-to-kidney contrast-to-noise ratio for solid masses with HASTE was almost equal to that with TSE. For cystic masses, the CNR with HASTE was significantly higher than that with TSE (p < 0.05). Respiratory and chemical shift artifacts were significantly smaller on HASTE than on TSE (p < 0.01). However, the blurring artifact was higher on HASTE than on TSE (p = 0.01). CONCLUSION: The HASTE sequence generates high contrast images and is free of motion and chemical shift artifacts, with much better time efficacy. The sequence provides comparable diagnostic information to TSE sequences.

[Clinical application of endoscopic ultrasonography (EUS) for gastrointestinal diseases].

Endoscopic mucosal resection (EMR) has been widely employed as a minimally invasive surgical procedure for early digestive cancers. Moreover, many recent reports emphasize the usefulness of endoscopic ultrasonography (EUS) for diagnosis of early gastrointestinal cancers. Generally, the normal gastrointestinal wall is visualized as having five layers by endosonographic probes of 7.5, 12, or 20 MHz. Delineation of these layers is the most important point for feature of EUS. Only mucosal cancers that are disclosed as hypoechoic masses within the first to second layer are indicated for EMR. The development of further extracorporeal applications such as color Doppler, 3-D, and aspiration biopsy EUS will contribute to the increased use of EUS in the near future.

Diagnostic accuracy of helical CT arterial portography and CT hepatic arteriography for hypervascular hepatocellular carcinoma in chronic liver damage. An ROC analysis.

PURPOSE: To evaluate the detectability of hypervascular hepatocellular carcinomas (HCCs) in chronic liver damage with helical CT arterial portography (CTAP) and CT hepatic arteriography (CTHA). MATERIAL AND METHODS: Thirty-nine HCC patients who underwent CTAP and CTHA were studied. Diagnostic abilities of CTAP alone, CTHA alone, or combined CTAP and CTHA were evaluated by receiver operating characteristic (ROC) analysis. Fifty-three images with 53 HCC nodules were evaluated. Tumor size ranged from 5 to 90 mm (mean 22.8 mm). Sensitivities and specificities for all techniques were calculated. RESULTS: ROC analysis showed the diagnostic ability significantly better with combined CTAP and CTHA (mean area under the ROC curve (Az)=0.95), or CTHA alone (Az=0.93) than CTAP alone (Az=0.87) (p<0.01). Combined CTAP and CTHA showed the best sensitivity (95.0%), followed by CTHA alone (88.1%) and CTAP alone (85.5%). The specificities of all three imaging techniques were relatively low (54.1% for combined CTAP and CTHA, 71.1% for CTHA alone, and 54.1% for CTAP alone) because of perfusion abnormalities of the liver parenchyma. CONCLUSION: The combination of CTAP and CTHA is superior to CTAP alone for detection of hypervascular HCCs. However, its specificity was relatively low in chronic liver damage.

Abdomen, pelvis, and extremities: diagnostic accuracy of dynamic contrast-enhanced turbo MR angiography compared with conventional angiography-initial experience.

To determine the value of contrast material-enhanced three-dimensional turbo magnetic resonance (MR) angiography compared with conventional cut-film or digital subtraction angiography for evaluating arterial stenosis in the abdomen, pelvis, and extremities. For detection of significant stenosis, MR angiography had 91% sensitivity and 89% specificity. This technique is highly sensitive in lesion detection, but stenosis tended to be overestimated.

Improved tissue characterization of focal liver lesions with ferumoxide-enhanced T1 and T2-weighted MR imaging.

The purpose of our study was to evaluate the potential value of ferumoxide-enhanced T1-weighted magnetic resonance (MR) imaging for tissue characterization of focal liver lesions when combined with T2-weighted sequences. Images were acquired within 30 minutes after the end of ferumoxide administration, when ferrite particles were not totally cleared from the intravascular compartment. Thirty-eight patients with 47 focal liver lesions underwent T1-weighted gradient-echo (TR/TE 150/4.1 msec) and T2-weighted fast spin-echo (3180-8638/90 msec) MR imaging at 1.5 T before and after intravenous administration of ferumoxides (10 micromol/kg body weight). A qualitative and quantitative analysis was performed. During the early phase after infusion of ferumoxide, blood vessels showed hypersignal intensity on T1-weighted fast low-angle shot (FLASH) images, while liver signal decreased. Hemangiomas showed both homogeneous and inhomogeneous enhancement patterns, and liver metastasis most typically showed ring enhancement. Hypervascular tumors (hepatocellular carcinomas and focal nodular hyperplasias) showed a slight degree of homogeneous enhancement. Quantitatively, the degree of enhancement and lesion-to-liver contrast on ferumoxide-enhanced images were significantly different among these tumors. Our results demonstrate that distinct enhancement patterns obtained on ferumoxide-enhanced T1-weighted MR imaging improve tissue characterization of focal liver lesions when combined with T2-weighted images.

Delineation of simulated vascular stenosis with Gd-DTPA-enhanced 3D gradient echo MR angiography: an experimental study.

PURPOSE: The purpose of this experimental study was to evaluate the influence of contrast material concentration and flow velocity on pulsatile flow in Gd-DTPA-enhanced 3D gradient echo MR angiographic sequence. METHOD: In vivo flow experiments were performed in Plexiglas phantoms with artificial stenosis (50% stenotic ratio and 20 mm stenotic length) attached to a cardiac pump that generated physiological pulsatile flow similar to that of the bloodstream in a closed circuit. We used a steady-state gradient echo sequence with different TEs (6, 3, and 1.4 ms). A TR of 15 ms was used for all parameters. The concentration of Gd-DTPA varied from 0 to 2.0 mmol/L and flow velocities from 25 to 80 cm/s. We measured the degree of stenosis and length of stenosis in comparison with the actual values. RESULTS: The degree and length of stenosis on 3D gradient echo MR angiographic images were markedly influenced by the velocity of the flow and concentration of Gd-DTPA. The degree of stenosis was overestimated when the flow was fast or when the concentration of Gd-DTPA was low. When the concentration of Gd-DTPA was low, stenosis was elongated. These effects were less prominent on short TE (1.4 ms) sequence. CONCLUSION: The stenotic lesions were markedly overestimated on MR angiographic images obtained with Gd-DTPA-enhanced fast 3D gradient echo sequence. Spin dephasing can be compensated for almost entirely by a high concentration of Gd-DTPA and/or a short TE sequence.

Diffuse perfusion abnormality of the liver parenchyma on angiography-assisted helical CT in relation to cirrhosis and previous treatments: a potential diagnostic pitfall for detecting hepatocellular carcinoma.

We evaluated diffuse perfusion abnormality of the liver parenchyma in relation to cirrhosis and previous treatments and estimated its potential limitation in detecting hepatocellular carcinomas (HCCs) on CT arterial portography (CTAP) and CT hepatic arteriography (CTHA). Sixty-one patients of liver cirrhosis with or without HCC received both CTAP and CTHA. Irregular defects of enhancement of the liver parenchyma on CTAP were noted in 37 of 61 patients (60.7%) and compensatory arterial perfusion in these defects on CTHA was noted in 30 of 37 patients (81.1%). Most patients had segmental or mixed patterns of enhancement. In patients with severe cirrhosis, irregular enhancement was often noted. The irregularity was also more often in patients who had had previous treatments. Four of 40 HCC nodules in 18 patients with severe irregular perfusion were not detected on CTAP and CTHA. Diffuse perfusion abnormalities of the liver parenchyma on CTAP and CTHA would decrease the accuracy of tumor detection in HCC patients.

Pancreaticobiliary ductal system: value of half-Fourier rapid acquisition with relaxation enhancement MR cholangiopancreatography for postoperative evaluation.

PURPOSE: To assess the usefulness of half-Fourier rapid acquisition with relaxation enhancement (RARE) magnetic resonance cholangiopancreatography (MRCP) for evaluation of postoperative changes in the pancreaticobiliary ductal system. MATERIALS AND METHODS: The study included 34 patients (20 men, 14 women; mean age, 65.5 years) who underwent surgery of the pancreaticobiliary ductal system. Half-Fourier RARE MRCP images were obtained after surgery. Qualitative evaluation included ratings by two observers for depiction of postoperative anatomy and for artifacts, as well as analysis of postoperative complications. Direct cholangiographic, computed tomographic, and ultrasonographic findings and 6-month follow-up results were the reference standard. Sensitivity, specificity, and accuracy were calculated for the evaluation of postsurgical complications seen at half-Fourier RARE MRCP. RESULTS: The sensitivity, specificity, and accuracy of MRCP for the evaluation of postsurgical complications were each 100% for ductal dilatation; 100%, 87%, and 89%, respectively, for choledochoenteric anastomotic stricture; 100%, 86%, and 87%, respectively, for pancreaticoenteric anastomotic stricture; 100% each for intraductal stones and anastomotic leakage; and 80%, 100%, and 94%, respectively, for cholangitis. CONCLUSION: Half-Fourier RARE MRCP is a reliable imaging technique for the evaluation of anatomy and of complications associated with a surgically altered pancreaticobiliary ductal system.

Optimal protocol for injection of contrast material at MR angiography: study of healthy volunteers.

Forty healthy volunteers, matched for age and body weight, underwent abdominal magnetic resonance angiography with gadopentetate dimeglumine administered by using a power injector. Injection rates were 0.3, 1.0, 2.0, or 3.0 mL/sec. Contrast material doses were 0.1 (single dose) or 0.2 (double dose) mmol/kg. Increased contrast enhancement in the aorta and minimum arteriovenous overlap can be achieved with high flow rate and double-dose injection.

Balloon-occluded retrograde transvenous embolization of a pelvic arteriovenous malformation.

We successfully performed embolization therapy for a pelvic arteriovenous malformation by the retrograde transvenous approach using a liquid embolic material. This malformation was unique in that it had a single draining vein, which allowed this technique employing an occlusion balloon.

Local extension of pancreatic carcinoma: assessment with thin-section helical CT versus with breath-hold fast MR imaging--ROC analysis.

PURPOSE: To compare contrast material-enhanced thin-section helical CT with breath-hold contrast-enhanced MR imaging for sensitivity in the detection of pancreatic adenocarcinoma and for accuracy in local tumor staging. MATERIALS AND METHODS: Fifty-seven patients (37 men, 20 women aged 42-28 years) suspected of having pancreatic adenocarcinoma were examined. The final diagnosis was confirmed at surgery to be pancreatic cancer in 31 patients; the other 26 patients were deemed not to have pancreatic cancer. All patients underwent both CT and MR imaging (turbo spin-echo and fast low-angle shot) studies. Image quality and pancreatic enhancement were subjectively evaluated. All CT scans and MR images were assessed by two independent observers by using a five-point scale for the detection of tumor and of invasion into the peripancreatic tissue, portal vein, and/or peripancreatic artery. Receiver operating characteristic curves for CT and MR imaging were analyzed. RESULTS: At visual analysis, pancreatic enhancement at CT and at MR imaging was comparable, but depiction of vessels was superior at helical CT. Detectability of tumor was comparable. Helical CT was significantly superior to MR imaging in diagnostic imaging of invasion into the peripancreatic tissue, portal vein, and/or peripancreatic artery (P < .01). CONCLUSION: Thin-section dynamic CT is more sensitive than MR imaging for detection of peripancreatic and vascular invasion in patients with pancreatic cancer.

Pitfalls in image reconstruction of helical CT angiography: an experimental study.

This study was undertaken to evaluate the effects of the object related factors: background tissue and the direction of vessels on the morphological reproducibility of helical CT angiography. Cylindrical tubes filled with a diluted contrast medium were prepared to obtain vascular phantoms. The scan was performed within various background tissues. For the evaluation of the direction of the vessels, two types of vascular phantoms were prepared. The phantoms were scanned by varying beam collimations and scan pitches. Reconstructed CT images were markedly affected by the background tissue. The reconstructed images were also affected by the direction of vessels.

Measurement of the apparent diffusion coefficient in diffuse renal disease by diffusion-weighted echo-planar MR imaging.

The purpose of this study was to determine the relationship between the apparent diffusion coefficient (ADC) and diffuse renal disease by diffusion-weighted echolanar magnetic resonance (MR) imaging (EPI). Thirty-four patients were examined with diffusion-weighted EPI. The average ADC values were 2.55 x 10(-3) mm2/sec for the cortex and 2.84 x 10(-3) mm2/sec for the medulla in the normal kidneys. The ADC values in both the cortex and medulla in chronic renal failure (CRF) kidneys and in acute renal failure (ARF) kidneys were significantly lower than those of the normal kidneys. In renal artery stenosis kidneys, the ADC values in the cortex were significantly lower than those of the normal and the contralateral kidneys. In the cortex, ADC values were above 1.8 x 10(-3) mm2/sec in all 32 normal kidneys, ranging from 1.6 to 2.0 x 10(-3) mm2/sec in all 8 ARF kidneys, and below 1.5 x 10(-3) mm2/sec in 14 of 15 CRF kidneys. In the medulla, there was considerable overlap in the ADC values of the normal and diseased kidneys. There was a linear correlation between ADC value and sCr level in the cortex (r = 0.75) and a weak linear correlation in the medulla (r = 0.60). Our results show that diffusion-weighted MR imaging may be useful to identify renal dysfunction.

Detection of hepatocellular carcinoma arising in cirrhotic livers: comparison of gadolinium- and ferumoxides-enhanced MR imaging.

OBJECTIVE: We prospectively compared the detectability of hepatocellular carcinoma (HCC) arising in cirrhotic livers using dynamic gadolinium-enhanced fast low-angle shot (FLASH), ferumoxides-enhanced T2-weighted turbo spin-echo, and ferumoxides-enhanced T2*-weighted FLASH MR imaging. SUBJECTS AND METHODS: Fifty-three patients with HCC (32 men and 21 women) who were 33-86 years old (mean, 63 years old) were enrolled in a prospective MR study to assess hepatic lesions using both gadopentetate dimeglumine and ferumoxides. Dynamic gadolinium-enhanced imaging was obtained before and 30, 60, and 180 sec after rapid bolus injection of gadopentetate dimeglumine (0.1 mmol/kg). Ferumoxides-enhanced T2-weighted turbo spin-echo imaging and ferumoxides-enhanced T2*-weighted FLASH imaging were performed between 30 min and 2 hr after i.v. infusion of ferumoxides (10 micromol/kg). Images were analyzed qualitatively and quantitatively. A receiver operating characteristic curve study was performed to compare the diagnostic value of gadolinium-enhanced imaging with that of ferumoxides-enhanced imaging for the detection of HCC. RESULTS: Quantitative analysis revealed a significantly higher percentage of signal-intensity loss and higher liver-lesion contrast-to-noise ratio on ferumoxides-enhanced T2*-weighted FLASH imaging than on ferumoxides-enhanced T2-weighted turbo spin-echo imaging. The percentage of signal-intensity loss and liver-lesion contrast-to-noise ratio on ferumoxides-enhanced images was significantly higher in patients with mild liver cirrhosis (Child's class A) than in patients with severe liver cirrhosis (Child's class C). Qualitative analysis showed that dynamic gadolinium-enhanced images revealed significantly higher lesion conspicuity than did ferumoxides-enhanced T2-weighted turbo spin-echo images. According to receiver operating characteristic analysis, dynamic gadolinium-enhanced FLASH imaging achieved the highest sensitivity, and ferumoxides-enhanced T2*-weighted FLASH imaging was the second most sensitive. We found that ferumoxides-enhanced turbo spin-echo imaging was the least valuable technique for revealing HCC lesions. Gadolinium-enhanced imaging revealed more HCC lesions than did ferumoxides-enhanced imaging, particularly for lesions smaller than 2 cm in diameter. CONCLUSION: Ferumoxides-enhanced imaging revealed fewer findings, such as lesion conspicuity of HCCs arising in cirrhotic livers, than did gadolinium-enhanced FLASH imaging.

CT evaluation of gastric lesions with three-dimensional display and interactive virtual endoscopy: comparison with conventional barium study and endoscopy.

OBJECTIVE: This study was undertaken to assess the feasibility of three-dimensional (3D) CT rendering using shaded-surface display (SSD) and ray sum display and virtual endoscopic images of the stomach for simultaneous evaluation of intraluminal and extraluminal abnormalities compared with conventional upper gastrointestinal barium studies and endoscopy. SUBJECTS AND METHODS: Our prospective study consisted of 39 patients with gastric lesions (17 gastric carcinomas, nine gastric polyps, five gastric varices, five gastric submucosal tumors, one lymphoma, one case of Menetrier's disease, and one gastric erosion) detected by endoscopy and barium study. All 3D CT images were reconstructed using SSD, ray sum display, and virtual endoscopic techniques. Three-dimensional images were evaluated for ability to reveal the range and morphologic features of the gastric lesions. RESULTS: All SSD, ray sum display, and virtual endoscopic images successfully revealed five of the eight early-stage gastric carcinomas and all nine advanced-stage gastric carcinomas. Submucosal tumors were revealed on 3D CT approximately as well as on conventional endoscopy. Interactive evaluation of virtual endoscopic images and multiplanar reconstructions provided useful information regarding intraluminal and submucosal gastric involvement by gastric varices, submucosal tumor, advanced gastric carcinomas, and lymphoma. This kind of information could not be obtained by conventional endoscopy or double-contrast study. CONCLUSION: Three-dimensional CT used in conjunction with virtual CT endoscopy proved helpful in identifying gastric lesions. Also, virtual CT endoscopic images with the interactive display of multiplanar reconstructions proved useful in identifying both intraluminal and submucosal components.

Power Doppler sonography assessment of tumor recurrence after chemoembolization therapy for hepatocellular carcinoma.

OBJECTIVE: This study was undertaken to determine the value of power Doppler sonography in the evaluation of recurrent hepatocellular carcinomas after transcatheter arterial chemoembolization therapy. SUBJECTS AND METHODS: Forty-five patients (age range, 45-81 years; mean age, 61 years) with hepatocellular carcinomas prospectively underwent power Doppler sonography, helical CT, and intraarterial digital subtraction angiography before and after transcatheter arterial chemoembolization therapy to evaluate for tumor recurrence. Three to 6 months after transcatheter arterial chemoembolization therapy, the Doppler signal, its location, and shape were evaluated. The results were compared with tumor vascularity as determined on helical CT and intraarterial digital subtraction angiography, which were used as the gold standards (n = 142). RESULTS: A sonographic signal was seen in 80 of 142 lesions with power Doppler sonography. Flow signal in lesions tended to be more difficult to detect in the left lobe (sensitivity, 74%) than in the right lobe (sensitivity, 93%). The location of the color signal was in the tumor's center, on its periphery, or both. No correlation between tumor recurrence and the location of a signal within a tumor was found. Power Doppler sonography had a sensitivity of 87%, a specificity of 85%, and an accuracy of 86% in revealing tumor recurrence after transcatheter arterial chemoembolization therapy. All lesions that showed linear signals in the center or at the periphery of the tumors proved to be recurring tumors (n = 20). In lesions with spotty signals, tumor recurrence was not revealed in nine of 60 lesions. CONCLUSION: Power Doppler sonography can be used for follow-up studies after transcatheter arterial chemoembolization therapy as a sensitive and cost-effective imaging technique. Although spotty signals were frequently seen, linear signals appeared to be specific for tumor recurrence.

Comparison of ultrafast half-Fourier single-shot turbo spin-echo sequence with turbo spin-echo sequences for T2-weighted imaging of the female pelvis.

So that we might evaluate the ultrafast half-Fourier single-shot turbo spin-echo (HASTE) sequence in T2-weighted MRI of the female pelvis and compare it with the turbo spin-echo (TSE) sequence, we prospectively studied 60 consecutive females with suspected abnormalities of the pelvis. For all MR examinations, we used a 1.5-T superconductive magnet with a phased array coil. The HASTE sequence was applied with TR/effective TE/echo train = infinity/90/64 and a 128 x 256 matrix (acquisition time: .3 sec/slice), conventional TSE imaging with 3,400 to 5,000/132/15 and a 128 x 256 matrix (mean acquisition time: 2 min 4 sec), and high-resolution TSE imaging with 3,400 to 5,000/132/15 and a 300 x 512 matrix (6 min 4 sec). Although the lesion conspicuity for the HASTE sequence was less than that for the high-resolution TSE sequences, artifacts (including ghosting, bowel motion, susceptibility difference, and chemical shift) were negligible on HASTE images of all patients. The lesion conspicuity for the HASTE sequence was significantly better than for the conventional TSE sequence. In spite of the very short acquisition time, the subjective scoring of the overall image quality for the HASTE sequence was significantly higher than for the conventional TSE sequence (P < .01) and were slightly lower than for the high-resolution TSE sequence. Compared with high-resolution TSE, HASTE provided clearer visualization of large leiomyomas and ovarian tumors but slightly poorer visualization of uterine cancer. In occlusion, HASTE sequence generates higher contrast and is free from motion and chemical shift artifact with much higher time efficacy. Because of limited image resolution, the HASTE sequence should be used when the high-resolution TSE imaging is suboptimal.

High resolution breath-holding MR imaging of the abdomen with a phased-array multicoil.

We prospectively compared standard resolution and high resolution breath-hold T1- and T2-weighted images of the upper abdomen with use of a body phased-array multicoil in 30 patients. The image quality of high resolution T1-weighted FLASH sequence was equal to that of standard resolution sequence, while the quality of high resolution T2-weighted turbo spin-echo sequence was slightly inferior to that of standard resolution sequence. The merit of high resolution image is appreciated especially on a T1-weighted FLASH sequence.

CT appearance of hepatic tumors after microwave coagulation therapy.

OBJECTIVE: The purpose of this study was to evaluate the changes in treated lesions and surrounding parenchyma of the liver as well as associated findings on CT in patients who underwent microwave coagulation therapy for hepatic tumors. MATERIALS AND METHODS: We retrospectively reviewed the findings on helical dynamic CT scans obtained before and after percutaneous or intraoperative microwave coagulation therapy for 74 lesions in 63 patients with hepatocellular carcinoma or metastatic hepatic tumors. Indications for microwave coagulation therapy included primary hepatic tumors in 54 patients and hepatic metastasis in nine patients. Sixty percent nonionic contrast material, infused at 3 ml/sec, was followed by sequential arterial phase, portal venous phase, and equilibrium phase helical CT of the entire liver in all patients. RESULTS: All lesions were hypodense and extended to the liver capsule. The lesions treated with percutaneous microwave coagulation therapy were teardrop-shaped, whereas those treated with intraoperative microwave coagulation therapy were round. Peripheral enhancement was seen on contrast-enhanced CT in 93% of the treated lesions immediately after microwave coagulation therapy; however, such enhancement disappeared on follow-up CT. Hemorrhage within the lesions and pleural effusion were found in nine patients. Complications detected on CT included intratumoral abscess (n = 4), subcapsular hematoma (n = 2), tumor dissemination (n = 3), ascites (n = 5), and portal vein thrombosis (n = 1). CONCLUSION: CT of the liver in patients undergoing microwave coagulation therapy showed findings that were dependent on the technique of therapy. Thus, CT scans must be carefully analyzed to avoid confusing results of therapy with findings that indicate complications requiring further treatment.