The angle of pancreaticobiliary junction correlates with acute pancreatitis: a magnetic resonance cholangiopancreatography study.

OBJECTIVE: To study the correlation between the angle of the pancreaticobiliary junction (APJ) and the prevalence of acute pancreatitis using magnetic resonance cholangiopancreatography (MRCP). MATERIALS AND METHODS: From February 2014 to October 2014, thirty two subjects with normal pancreas (group A) and 40 patients with acute pancreatitis (group B) who underwent MRCP were enrolled into our study. The type of biliary duct and main pancreatic duct joining the duodenal wall was reviewed and divided into V, B-P and P-B type. The V type is the pancreatic duct and biliary duct joining the duodenal wall without a common channel; the B-P type is the biliary duct draining into the pancreatic duct and forming a common channel; and the P-B type is the pancreatic duct draining into the biliary duct and forming a common channel. APJ was measured on MRCP. The correlation between the APJ and the prevalence of acute pancreatitis was analyzed. RESULTS: The APJ in group A was smaller than in group B (51.45°±13.51° vs. 65.76°±15.61°, P<0.05). According to the type of biliary duct and main pancreatic duct joining the duodenal wall, the prevalence of acute pancreatitis in the V type and in the B-P type was higher than in the P-B type (12/17 vs. 10/29, or 18/26 vs. 10/29, respectively, all P<0.05), whereas there were no significant difference for the prevalence of acute pancreatitis between the V type and B-P type (P>0.05). The APJ were 59.32°±20.04°, 60.22°±11.06°, 57.13°±17.27°, respectively in V type, B-P type and P-B type joining of main pancreatic duct (P>0.05). CONCLUSIONS: A larger APJ is related to a higher prevalence of acute pancreatitis.

The features of extrahepatic collateral arteries related to hepatic artery occlusion and benefits in the transarterial management of liver tumors.

Purpose. To investigate the extrahepatic collateral arteries related to hepatic artery occlusion (HAO) and to determine its benefits in the transarterial management of liver tumors. Methods and Findings. Eleven patients (7 hepatocellular carcinomas, 3 liver metastases, and 1 with hemangioma) with HAO confirmed with digital subtraction angiography (DSA) were admitted to our hospital. Of the 11 patients, 7 were men and 4 were women, with an average age of 41.5 ± 15.5 years (range: 29 to 70 years). DSA was performed to evaluate the collateral routes to the liver. In the 11 patients with HAO, DSA showed complete occlusion of the common hepatic artery in 9 patients and the proper hepatic artery (PHA) in 2 patients. Extrahepatic collateral arteries supplying the liver were readily evident. The collateral arteries originated from the superior mesenteric artery (SMA) in 8 patients, from the gastroduodenal artery in 2 patients, and from the left gastric artery (LGA) in 1 patient. Transcatheter treatment was successfully performed via the collateral artery in all patients except the one who had hemangioma. Conclusions. DSA is an effective method for detecting collateral circulation related to HAO and may provide information to guide transcatheter management decisions.

The diameter of the originating vein determines esophageal and gastric fundic varices in portal hypertension secondary to posthepatitic cirrhosis.

OBJECTIVE: The aim of this study was to determine whether and how the diameter of the vein that gives rise to the inflowing vein of the esophageal and gastric fundic varices secondary to posthepatitic cirrhosis, as measured with multidetector-row computed tomography, could predict the varices and their patterns. METHODS: A total of 106 patients with posthepatitic cirrhosis underwent multidetector-row computed tomography. Patients with and without esophageal and gastric fundic varices were enrolled in Group 1 and Group 2, respectively. Group 1 was composed of Subgroup A, consisting of patients with varices, and Subgroup B consisted of patients with varices in combination with portal vein-inferior vena cava shunts. The diameters of the originating veins of veins entering the varices were reviewed and statistically analyzed. RESULTS: The originating veins were the portal vein in 8% (6/75) of patients, the splenic vein in 65.3% (49/75) of patients, and both the portal and splenic veins in 26.7% (20/75) of patients. The splenic vein diameter in Group 1 was larger than that in Group 2, whereas no differences in portal vein diameters were found between groups. In Group 1, the splenic vein diameter in Subgroup A was larger than that in Subgroup B. A cut-off splenic vein diameter of 8.5 mm achieved a sensitivity of 83.3% and specificity of 58.1% for predicting the varices. For discrimination of the varices in combination with and without portal vein-inferior vena cava shunts, a cut-off diameter of 9.5 mm achieved a sensitivity of 66.7% and specificity of 60.0%. CONCLUSION: The diameter of the splenic vein can be used to predict esophageal and gastric fundic varices and their patterns.

Computed tomographic perfusion imaging for the therapeutic response of chemoembolization for hepatocellular carcinoma.

BACKGROUND: Computed tomographic (CT) perfusion imaging has been applied in many clinical areas, but few studies have addressed the values of CT perfusion imaging in evaluating the therapeutic response of chemoembolization for hepatocellular carcinoma (HCC). OBJECTIVE: To assess the perfusion changes of HCC after transarterial chemoembolization, and to investigate the values of CT perfusion imaging in chemoembolization procedure. METHODS: Multidetector computed tomographic perfusion imaging was performed in 24 patients with HCC 1 week before and 4 weeks after chemoembolization. The CT perfusion parameters, including hepatic arterial perfusion (HAP), hepatic portal perfusion (HPP), total liver perfusion (TLP), and hepatic arterial perfusion index (HAPI), were calculated by using the slope method. The t statistic was used to analysis the difference of CT perfusion parameter values before and after chemoembolization therapy. RESULTS: The values of HAP, TLP, and HAPI in tumors 4 weeks after chemoembolization were significantly decreased than those before chemoembolization (P < 0.05), but the value of HPP in tumors was not (P > 0.05). CONCLUSION: Computed tomographic perfusion imaging has the ability to evaluate the perfusion changes in HCC after chemoembolization, which can be used to evaluate the therapeutic response of chemoembolization for hepatocellular carcinoma.

The diameter of the originating vein determines esophageal and gastric fundic varices in portal hypertension secondary to posthepatitic cirrhosis

OBJECTIVE: The aim of this study was to determine whether and how the diameter of the vein that gives rise to the inflowing vein of the esophageal and gastric fundic varices secondary to posthepatitic cirrhosis, as measured with multidetector-row computed tomography, could predict the varices and their patterns. METHODS: A total of 106 patients with posthepatitic cirrhosis underwent multidetector-row computed tomography. Patients with and without esophageal and gastric fundic varices were enrolled in Group 1 and Group 2, respectively. Group 1 was composed of Subgroup A, consisting of patients with varices, and Subgroup B consisted of patients with varices in combination with portal vein-inferior vena cava shunts. The diameters of the originating veins of veins entering the varices were reviewed and statistically analyzed. RESULTS: The originating veins were the portal vein in 8% (6/75) of patients, the splenic vein in 65.3% (49/75) of patients, and both the portal and splenic veins in 26.7% (20/75) of patients. The splenic vein diameter in Group 1 was larger than that in Group 2, whereas no differences in portal vein diameters were found between groups. In Group 1, the splenic vein diameter in Subgroup A was larger than that in Subgroup B. A cut-off splenic vein diameter of 8.5 mm achieved a sensitivity of 83.3% and specificity of 58.1% for predicting the varices. For discrimination of the varices in combination with and without portal vein-inferior vena cava shunts, a cut-off diameter of 9.5 mm achieved a sensitivity of 66.7% and specificity of 60.0%. CONCLUSION: The diameter of the splenic vein can be used to predict esophageal and gastric fundic varices and their patterns.

Correlation between tumor perfusion and lipiodol deposition in hepatocellular carcinoma after transarterial chemoembolization.

PURPOSE: To study the correlation of tumor perfusion with lipiodol deposition in hepatocellular carcinoma (HCC) after transarterial chemoembolization with multidetector computed tomography (MDCT) perfusion imaging. MATERIALS AND METHODS: MDCT perfusion imaging was performed in 24 patients with HCC 1 to 7 days before chemoembolization. The computed tomography (CT) perfusion parameters, such as hepatic arterial perfusion (HAP), hepatic portal perfusion (HPP), total liver perfusion (TLP), and hepatic arterial perfusion index (HAPI), were calculated with the slope method. The follow-up CT scans (noncontrast) were performed 4 weeks after chemoembolization to analyze lipiodol deposition. The lipiodol deposition in the tumor was classified into three grades and compared with CT perfusion parameters before chemoembolization. RESULTS: The HAP and TLP of tumors before chemoembolization were correlated with the grades of lipiodol deposition in tumors after chemoembolization (r = 0.768, P < .0001 and r = 0.616, P = .001, respectively). However, the HPP and HAPI of the tumors were not related to the grades of iodized oil deposition (r = 0.227, P = .286 and r = 0.111, P = .607, respectively). Higher HAP was correlated with better lipiodol deposition, and lower HAP was correlated with poorer lipiodol deposition. CONCLUSIONS: MDCT perfusion imaging has the potential to help select more appropriate patients with HCC for chemoembolization.