[Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma. Value and prognostic factors of hepatic artery embolization]. / Hémopéritoine par rupture spontanée de carcinome hépatocellulaire. Intérêt et facteurs pronostiques de l'embolisation artérielle hépatique.

To assess efficiency and to determine prognostic factors in emergency embolization for intraperitoneal hemorrhage from hepatocellular carcinoma we retrospectively analyzed 12 consecutive procedures. In order to evaluate the extension of tumor thrombus in the intrahepatic portal system before embolization, a portal perfusion rate was defined as the relative patency of the segmental portal veins demonstrated at arteriography. Serum bilirubin level and portal perfusion rate were correlated with length of survival. Successful hemostasis was achieved in all patients. Mean length of survival was 149 days. Two patients are still alive 545 and 195 days, respectively, after the procedure. A significant correlation (p = 0.005) between portal perfusion rate and length of survival was obtained. There was no correlation between serum bilirubin level and prognosis. Emergency embolization is an effective treatment in patients with intraperitoneal hemorrhage from hepatocellular carcinoma. Prognosis depends of portal perfusion rate.

[Failure factors in X-ray computed tomography-guided biopsy of pulmonary lesions: analysis of 103 consecutive biopsies]. / Facteurs d'échec de la biopsie guidée par tomodensitométrie des lésions pulmonaires: analyse de 103 biopsies consécutives.

OBJECTIVE: Percutaneous biopsy of pulmonary lesions with use of CT-guidance is well established and relatively safe. Reported accuracy rates are 64%-90% and major complications are rare. To determine the failure factors of CT-guided biopsy of lung lesions, we retrospectively analyzed 103 consecutive procedures. MATERIALS AND METHODS: Fourteen characteristics of the biopsy procedure were analyzed, including size, location, skin-lesion and chest wall-lesion distances, operator experience, procedure type (histology and/or cytology), histologic definite diagnosis, and other. RESULTS: Overall success rate was 88%. Success rate was correlated with the size of the lesion 4.3 +/- 2.9 cm for the positive results versus 2 +/- 1.2 cm for the negative results (p < 0.01). Skin- and chest wall-lesion distances were 5.8 +/- 2.2 and 1.5 +/- 1.8 respectively for positive results and 8.3 +/- 2.9 and 3.7 +/- 2.5 for negative results (p < 0.001). The overall complication rate for pneumothorax was 17%. Chest wall-lesion distances were 3.3 +/- 1.8 cm for complicated procedures and 1.5 +/- 1.9 cm for uncomplicated procedures (p < 0.001). No other factor was significantly correlated with the risk of pneumothorax. CONCLUSION: Small lesion size, long skin- and chest wall-lesion distances are significant predictive failure factors. Long chest wall-lesion distance is significantly correlated with the complication rate for pneumothorax.

Hepatic tumors: detection and characterization at 1-T MR imaging enhanced with AMI-25.

PURPOSE: To evaluate the ability of magnetic resonance (MR) imaging enhanced with AMI-25 to depict and characterize hepatic tumors. MATERIALS AND METHODS: Sixty-four patients (41 men and 23 women, aged 24-65 years [mean, 55 years]) underwent 1-T MR imaging: 22 had metastatic disease; 10, hepatocellular carcinoma; seven, hemangioma; three, focal nodular hyperplasia; three, gallbladder adenocarcinoma; two, lymphoma; one, adenoma; and 16, no tumor. Pre- and postcontrast images (alone and in combination) were analyzed by three independent radiologists. Receiver operating characteristic curves were constructed to compare tumor characterization. RESULTS: Signal intensity was decreased in all benign tumors but not in malignant tumors. The number of tumors depicted (nonenhanced images, 657 tumors; enhanced, 753; and combined, 760) was not statistically different. Receiver operating characteristic curves did not show improved characterization with AMI-25. CONCLUSION: AMI-25 does not improve depiction of hepatic tumors. Although characterization of hepatic tumors was not improved with AMI-25, uptake of AMI-25 seems specific for hepatic tumors at MR imaging.

Hepatic adenoma: MR findings in 51 pathologically proved lesions.

PURPOSE: To describe the magnetic resonance (MR) imaging features of hepatic adenoma and correlate these findings with histopathologic findings. MATERIALS AND METHODS: MR findings of 51 pathologically proved hepatic adenomas in 29 consecutive patients were retrospectively analyzed. T1- and T2-weighted spin-echo (SE) images were obtained in all patients, and contrast material-enhanced MR images were obtained in 16 patients. RESULTS: At pathologic analysis, a peripheral rim, observed in 16 (31%) hepatic adenomas, corresponded to pseudocapsule, and tumor heterogeneity, observed in 26 (51%) lesions, corresponded to hemorrhagic necrosis and peliosis. Hyperintensity on T1-weighted SE images was observed in 30 (59%) adenomas; 10 (67%) of 15 hepatic adenomas were hyperintense on contrast-enhanced gradient-echo images, and 13 (45%) of 29 were hyperintense on delayed contrast-enhanced T1-weighted SE images. CONCLUSION: Presence of a peripheral rim, heterogeneity, and hyperintensity are common features of hepatic adenoma.

Nontumorous attenuation changes on CT arterial portography.

OBJECTIVE: We prospectively studied the frequency and the distribution of nontumorous attenuation changes during CT arterial portography. MATERIALS AND METHODS: Computed tomography arterial portograms were obtained in 67 consecutive patients. The frequency and distribution of nontumorous attenuation changes (pseudolesions, areas of hypo- or hyperperfusion) were analyzed and related to the size of the tumor, the vascular status assessed by Doppler examination, and the presence of chronic liver disease. RESULTS: Pseudolesions were detected in 19 patients (28%). They were typical in 13 cases and atypical (round shaped or located in the caudate or right lobe) in 6. Segmental, lobar, or diffuse perfusion defects were seen in 36 patients (54%). In 56% of the cases, they were adjacent to large tumors and related to compression or thrombosis of intrahepatic portal branches as demonstrated by sonographic and Doppler findings. Areas of hyperperfusion were detected in 14 patients (21%). Of these cases, eight (57%) were peritumoral hyperperfusion. In all cases, the mean diameter of the tumors was large and there was compression of adjacent hepatic vein as demonstrated by sonographic and Doppler findings. CONCLUSION: Nontumorous attenuation changes are common in CT arterial portography. Factors leading to these artifacts include size of the tumor and vascular consequences of the tumor. Sonographic and Doppler studies may play a role in predicting these factors.

Open window thoracostomy, myoplasty, and epiploplasty for treatment of postpneumonectomy empyema: CT evaluation.

PURPOSE: To demonstrate the computed tomographic (CT) appearance of the postpneumonectomy space (PPS) after surgical treatment of postpneumonectomy empyema. MATERIALS AND METHODS: The authors retrospectively reviewed 22 CT scans obtained in 15 patients after open window thoracostomy (OWT) (n = 4), myoplasty (n = 12), and epiploplasty (n = 1). RESULTS: After uncomplicated OWT, the retracted PPS contained air and/or gauze without residual pleural fluid. After uncomplicated myoplasty, marked retraction of the operated hemithorax was observed. CT allowed localization of transposed muscle flaps and fatty tissue within the PPS. A moderate amount of fluid and air was present during the 1st month after surgery. After uncomplicated epiploplasty, the retracted PPS contained homogeneous tissue with characteristic fatty attenuation. Complications including recurrent empyema, recurrent bronchopleural fistula, aseptic fluid collection, necrosis and fatty transformation of muscle flaps, and tumor recurrence were accurately demonstrated. CONCLUSION: CT is useful in follow-up after surgical treatment of postpneumonectomy empyema because it permits accurate evaluation of the PPS.

Cine MRI of mitral regurgitation in planes angled along the intrinsic cardiac axes.

OBJECTIVE: This prospective study was designed to evaluate the mechanism and severity of mitral regurgitation (MRG) by means of cine MRI using planes angled along the intrinsic cardiac axes. MATERIALS AND METHODS: In 25 patients with MRG, analysis of the direction, extent, and distribution of left atrial signal void area was performed on both two chamber and four chamber cine MRI views. Cine MRI features including qualitative grading, maximal length of regurgitant jet, and ratio of regurgitant jet area to left atrial area were compared with the results of color flow Doppler (CFD) mapping (n = 25), angiography (n = 20), and regurgitant fraction as determined at catheterization (n = 15). RESULTS: In the four chamber view, cine MRI demonstrated central extension of regurgitant jet (n = 8) in cases with dilatation of valve annulus or retraction of both mitral valve leaflets, anterior extension (n = 8) in cases with prolapse of the posterior leaflet, and posterior extension (n = 7) in cases with prolapse of the anterior leaflet or retraction of the posterior leaflet. In two cases of mild MRG with small signal void area, evaluation of mechanism was not feasible. The results of cine MRI and angiographic qualitative gradings were the same in 19 of the 20 patients and differed by one grade in the other patient. In the 25 patients, maximal length of the regurgitant jet was well correlated with both regurgitant jet area and ratio of the jet area to the left atrial area as determined by CFD mapping (r = 0.91, r = 0.85, p < 0.0001, respectively). In 15 patients the maximal length of regurgitant jet was correctly correlated with regurgitant fraction determined at catheterization (r = 0.76, p < 0.001). CONCLUSION: Cine MRI by means of planes angled along the intrinsic cardiac axes allows assessment of both the mechanism and the severity of MRG.

MRI and cine MRI of asymmetric septal hypertrophic cardiomyopathy.

OBJECTIVE: This study was designed to determine MR and cine MR characteristics of asymmetric septal hypertrophic cardiomyopathy and to correlate MR and cine MR features with the severity of left ventricular outflow tract obstruction. MATERIALS AND METHODS: Ten consecutive patients with asymmetric septal hypertrophic cardiomyopathy [resting obstructive (n = 3), latent obstructive (n = 4), nonobstructive hypertrophic (n = 3)] and five healthy volunteers underwent MRI and cine MRI. Oblique two chamber and four chamber views were obtained in all cases. RESULTS: In the 10 patients, the mean +/- SD end-diastolic myocardial thickness was 22.7 +/- 6.3 mm in the basal septum and 13 +/- 3.9 mm in the posterolateral wall with a ratio of 1.76 +/- 0.30; the corresponding values were 10.6 +/- 1.1, 10.4 +/- 1.1, and 1.02 +/- 0.08 mm, respectively, in five healthy volunteers. The mean systolic thickening of the basal septum was 22 +/- 12%. This value was 49 +/- 4% in the five healthy volunteers. In resting obstructive hypertrophic cardiomyopathy, septal wall thickness was > or = 25 mm with a systolic thickening of 10%. A systolic anterior motion of the mitral valve was demonstrated in four patients with resting subaortic pressure gradients ranging from 28 to 120 mm Hg. A signal void area was demonstrated within the left ventricular outflow tract during systole in the seven patients with obstructive cardiomyopathy. This signal void area reached its maximum during early systole in the most severe obstructions and during midsystole in the less severe obstructions. CONCLUSION: In patients with asymmetric septal hypertrophic cardiomyopathy, gross correlation was demonstrated between severity of obstruction and several MR and cine MR features including increased end-diastolic thickness of the septal wall, decreased systolic thickening of the septal wall, systolic anterior motion of the mitral valve, and signal void area within the left ventricular outflow tract during systole.

Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients.

Thirty-seven patients with 48 lesions of focal nodular hyperplasia (FNH) underwent preoperative magnetic resonance (MR) examination and surgical resection. Sixteen lesions were imaged at 0.5 T with T1- and T2-weighted spin-echo sequences; 32 lesions were imaged at 2 T with T1-and T2-weighted spin-echo and gradient-recalled-echo sequences. Contrast material-enhanced MR imaging was performed in 20 lesions. MR imaging failed to depict six tumors that were less than 3 cm in diameter. Typical appearance was present in 18 of the 42 (43%) lesions seen at MR. Atypical lesion features included no scar (n = 15), hypointense scar on T2-weighted images (n = 7), pseudocapsule (n = 6), strong hyperintense lesion on T2-weighted images (n = 3), diffuse hyperintensity on T1-weighted images (n = 3), and heterogeneous lesion (n = 1). Comparison between findings at MR imaging and at histopathologic examination was performed in 38 lesions: There was good correlation between presence and size of the scar on both examinations. In 13 of 20 (65%) of the hyperintense scars on T2-weighted images, edema was prominent, whereas in five of the seven (71%) hypointense scars on T2-weighted images, edema was absent or low.

US-guided percutaneous liver biopsy with plugging of the needle track: a prospective study in 72 high-risk patients.

The efficiency, accuracy, and safety of ultrasound-guided liver biopsy with plugging of the needle track were prospectively assessed in 72 patients at high risk for hemorrhage. Seventy-eight biopsy procedures were performed in 72 consecutive patients prospectively classified into four different groups on the basis of coagulation parameters. Sixty-two patients (86%) had severe or moderately severe coagulation disorders. Fifty-four biopsy procedures were performed in 50 patients with diffuse liver disease, and 24 were performed in 24 patients with focal liver lesions. The biopsy track was embolized with gelatin particles and thrombin. Biopsy specimens adequate for histologic diagnosis were obtained in 69 of the 72 patients (96%). In focal lesions, accuracy and sensitivity in the diagnosis of malignancy were 75% and 89%, respectively. Two serious bleeding complications (2.8%) were encountered in two of the patients with major coagulation disorders. Liver biopsy with plugging of the needle track is a practical technique and is a feasible alternative to the transjugular approach. Respective indications for both methods depend on the severity of coagulation disorders and the presence of focal lesions.

Diagnosis of abdominal venous thrombosis by means of spin-echo and gradient-echo MR imaging: analysis with receiver operating characteristic curves.

The authors compared the accuracy of spin-echo (SE) and gradient-echo (GRE) magnetic resonance images in diagnosis of abdominal venous thrombosis. Images of 292 abdominal veins in 72 patients were reviewed in a blinded manner by three radiologists, with seven levels of confidence for diagnosis. Corroborative studies proved thrombosis (n = 95) and vessel patency (n = 197). Receiver operating characteristic (ROC) curves were constructed for SE images alone, GRE images alone, and SE and GRE images combined. At specificities of 90% and 95%, thrombi were identified with sensitivities, respectively, of 76% and 63% with SE images, 74% and 58% with GRE images, and 88% and 82% with combined SE and GRE images. The area under the ROC curve for SE and GRE images combined (0.958 +/- 0.011 [standard deviation]) was significantly larger (P less than .001) than that for SE images alone (0.913 +/- 0.018) and GRE images alone (0.921 +/- 0.016). It is concluded that combination of SE and GRE images significantly increases the accuracy of diagnosis of abdominal venous thrombosis.