Histopathologic correlation of hepatocellular carcinoma after transcatheter arterial chemoembolization with polyvinyl alcohol particle of various sizes.

AIM: Transcatheter arterial chemoembolization (TACE) is one of major treatment for unresectable hepatocellular carcinomas (HCC) and has been used as a neoadjuvant treatment before surgery. This study was to describe the histopathologic features of HCC after TACE with variously sized polyvinyl alcohol (PVA) particles. MATERIALS AND METHODS: Seventeen patients undergoing TACE with PVA followed by surgery for HCC were analyzed. The PVA particles used in TACE were categorized into two groups in respects of particle sizes: the group I, 47-90 µm (n=8) and the group II, >90-250 µm (n=9). The histopathologic features of the resected HCC were characterized with the emphasis on the number of thrombosed vessels and minimal diameter of arterioles/capillaries containing polyvinyl alcohol particles. The clinical results after TACE were also addressed. RESULTS: Histopathologic examinations showed that the median minimal diameters of arterioles containing PVA particles were 0.035 mm in group I and 0.06 mm in group II (p=0.0078). We observed the PVA particle in the sinusoidal spaces of non-tumourous liver in only one patient. However, no sinusoidal infarction was demonstrated in either group. Mean tumour necrosis rate was 67% vs. 61% for the group I and II, respectively. CONCLUSIONS: The smaller PVA particles can reach and occlude more distal arteriolar capillaries, but rarely leak into non-tumourous hepatic sinusoidal spaces. Slightly better tumour necrosis rate after TACE can be achieved.

Use of two-dimensional multiple-slice magnetic resonance hydrography for diagnosis of hepatic hemangiomas and cysts.

BACKGROUND/PURPOSE: Although hepatic hemangiomas and cysts display very high signal intensities on conventional T2 images, their appearances are quite distinct using magnetic resonance hydrography (MRH). We examined the feasibility of using MRH in distinguishing hepatic cysts from hemangiomas. METHODS: We recruited 97 patients with hepatic hemangiomas and 65 with hepatic cysts. All patients underwent magnetic resonance imaging (including two-dimensional multiple slice MRH, TR/TE: 8000/800) and the results were reviewed independently by two radiologists. The signal intensities of the lesions were measured. For each lesion, the variation in signal to noise ratio between MRH and the fat-saturated T2-weighted images was calculated, and the results were validated using a receiver operating characteristic curve. RESULTS: There was a significant difference between the signal to noise ratio of hepatic hemangiomas and cysts using MRH (p < 0.001). This difference could be identified by visual inspection. The receiver operating characteristic curve revealed that the ideal cut-off value for the signal intensity reduction ratio between hepatic cysts and hemangiomas was -0.1. Using this ratio, the derived sensitivity was 95.4%, specificity 99.0%, and accuracy 99.7%. CONCLUSION: Hepatic hemangiomas and cysts have significantly different signal intensities on non-contrast two-dimensional multiple-slice MRH. This approach uses a non-invasive, reliable, and accurate imaging technique to differentiate the two diagnoses.

Identification of chromosomal aberrations associated with disease progression and a novel 3q13.31 deletion involving LSAMP gene in osteosarcoma.

Five osteosarcoma (OS) cell lines, 37 OS tumors and 9 corresponding non-neoplastic samples were genotyped by Affymetrix 10 K 2.0 SNP array. Regions of high level amplification and homozygous deletion were identified and validated by quantitative PCR and FISH. Certain recurrent cytogenetic alterations were more frequent in recurrent/metastatic than in primary OS. These included deletion of 6q14.1, 6q16.2-q22.31, and 8p23.2-p12, amplification of 8q21.12, 8q22.3-q24.3 and 17p12, and loss of heterozygosity (LOH) at 2q24.3-q31.2, 5q11.2, 6p21.31-p21.1, 6q14.1-q16.2, 8p22-p12, 9q22.1, 10q21.1-q22.1, 10q23.31-q24.1, 12q15-q21.1 and 21q21.2-q21.3. Most of the LOH calls were associated with deletion, but a subset of them was associated with normal or increased copy number (CN). A consensus 3q13.31 deletion localized to a region within the limbic system-associated membrane protein (LSAMP) gene was also identified. The FISH evaluations demonstrated highly-localized homozygous or heterozygous LSAMP deletions in 6 of 11 primary OS. qRT-PCR evaluations of the two major alternative LSAMP transcripts demonstrated reduced expression of 1b isoform transcript in each of three OS with LSAMP exon 1b deletion. Further, the 1a isoform transcripts in these same OS had either reduced expression or a premature termination codon in LSAMP exon 2. This SNP genotyping study identified chromosomal aberrations associated with disease progression in OS and disclosed LSAMP as a novel tumor suppressor gene in OS. The study also demonstrated that CN and LOH analyses were able to detect distinct subsets of genetic abnormalities in OS.

Differentiating benign and malignant soft tissue masses by magnetic resonance imaging: role of tissue component analysis.

BACKGROUND: There is a variable degree of accuracy in discriminating benign from malignant soft tissue masses based on signal intensity and morphologic characteristics by magnetic resonance imaging (MRI). The aim of this study was to determine the utility of detailed component pattern assessment, in addition to morphologic study, for differentiating benign from malignant soft tissue masses by MRI. METHODS: The imaging features of 118 histologically proven soft tissue masses were analyzed according to: (1) signal characteristics: (a) high T1 matrix; (b) low T2 matrix; (c) fibrous tissue signal; (d) calcification; (e) myxoid signal tissue; (f) fatty signal tissue; (g) cystic signal; (h) necrotic signal; (i) septations; (j) vascular signal void signal; (k) fat rim; and (l) hemorrhage; and according to (2) morphologic assessment: (a) lesion size (maximal diameter) in centimeters (cm); (b) lesion depth in cm; (c) margins; (d) peritumoral edema; (e) bone involvement; (f) marginal capsule or pseudocapsule; and (g) neurovascular bundle involvement. Univariate and multivariate analyses followed by stepwise logistic regression of combination of imaging features were performed. The predictive value of each imaging feature and various combinations of imaging features were determined. RESULTS: In univariate analysis, T2 low signal matrix, fibrous tissue, calcification, necrosis, septum, fat rim sign, peritumoral edema, and hemorrhage showed statistically significant differences between benign and malignant masses (p < 0.05). The positive predictive value of necrosis for malignancy was 84.8%, and its specificity was 90.9%. In multivariate analysis, the best model for predicting malignant masses was the combination of necrosis, maximal mass diameter, peritumoral edema, and absent fibrosis, absent calcification, and lack of fat rim. The combination of these parameters resulted in the most correct diagnoses of malignancy, with a sensitivity of 84.2%, specificity of 64.0%, and accuracy of 74.8%, whereas the accuracy of models consisting of component character and morphologic feature were 74.3% and 70.9%, respectively. CONCLUSION: MRI is useful in determining whether a soft tissue mass is malignant or not. Traditional morphologic assessment was reinforced by detailed component characterization analysis. The parameters favoring malignancy were large lesion size, peritumoral edema, necrosis, and absent calcification, absent fibrosis, and lack of fat rim.

Computed tomography features of acute pulmonary tuberculosis.

The purpose of this study was to demonstrate the computed tomography (CT) features of pulmonary tuberculosis in patients with acute clinical manifestations. The emergent CT images of 46 non-AIDS patients with acute clinical presentations of pulmonary tuberculosis (TB) were analyzed. The distribution and characterization of the pulmonary and pleural lesions were specifically focused. Multifocal airspace consolidation in multiple lobes was most commonly seen on the CT in 32 of 46 patients (70%), followed by cavitary pulmonary nodular shadows (50%). Other CT manifestations included pleural effusion (40%), TB empyema (20%), and lymphadenopathy (11%). On followup, 12 patients (26%) developed acute respiratory failure. Patients presenting with multifocal pulmonary consolidation, with or without cavitations, on CT should undergo early pulmonary TB workup. These findings could help early detection for pulmonary TB.

Aberrant ascending pharyngeal artery mimicking a partially occluded internal carotid artery.

Doppler sonography has become a primary imaging modality for the diagnosis of carotid arterial stenosis. Carotid stenting for a severely stenotic but not completely occluded carotid artery is becoming an alternative to carotid endarterectomy in selected groups of patients. The authors discuss a case of complete occlusion of the internal carotid artery associated with an ipsilateral aberrant ascending pharyngeal artery originating from the proximal internal carotid artery, which mimicked a stenotic internal carotid artery on sonography. Meticulous Doppler sonographic examination may provide clues for this extraordinary condition, yet angiography is indicated for a definite diagnosis.

Diagnostic value of unenhanced computerized tomography urography in the evaluation of acute renal colic.

This study prospectively evaluated the diagnostic value of unenhanced computerized tomography (CT) urography in patients with acute renal colic. Fifty-nine patients with clinical manifestations of acute renal colic underwent unenhanced helical CT to evaluate urinary tract abnormalities. Reformatted three-dimensional CT urography was performed in all patients. The findings were correlated with ureteroscopy, surgical findings, histopathologic findings, and clinical course. CT urography detected urinary abnormalities in 57 of 59 patients with the clinical manifestation of acute renal colic, including 45 cases of urolithiasis, three urinary malignancies, one congenital abnormality, and eight ureteral strictures (due to chronic inflammation or fibrosis). CT urography showed negative findings in the urinary system in two patients, and after clinical follow-up, urinary abnormality was excluded in these patients. Incidental findings of extrarenal disease were noted in six patients (pulmonary abnormalities, n = 2; gallstones, n = 4). Only one patient with urolithiasis was misdiagnosed as having a renal tumor by CT urography. The sensitivity and specificity of CT urography in diagnosing urolithiasis was 97.8% (44/45) and 100% (14/14), respectively. Three-dimensional CT urography is a newly developed modality to evaluate anomalies of the urinary tract. The highly accurate diagnostic value of CT urography makes it a suitable alternative or substitutive modality in patients with acute flank pain.

Stent-assisted embolization of internal carotid artery aneurysms.

BACKGROUND: Endovascular embolization of wide neck aneurysm often results in incomplete occlusion or aneurysm recurrence. The purpose of this study is to assess the efficacy and safety of stent-assisted embolization of wide neck aneurysms of the internal carotid artery (ICA). METHODS: A series of 10 patients with ICA aneurysms attempted treatment by stent-assisted Guglielmi detachable coil (GDC) embolization (n = 9) or by stent alone (n = 1). There were 3 men and 7 women ranging in age from 21 to 78 years, with a mean of 51 years. The indications of stenting were wide neck aneurysms (n = 9) and herniation of detached coils from aneurysmal sac into parent artery (n = 1). RESULTS: Endovascular stent placement was technically successful in 8 cases. In one case with a cervical big ICA aneurysm, a stent was placed across the neck of aneurysm without deposition of embolic material into the aneurysmal sac. The initial control angiogram revealed residual aneurysm; however, complete obliteration of aneurysmal sac was achieved as observed on angiograms in 8 months. Six cases of wide neck aneurysms were successfully treated by stent-assisted GDC embolization. One case had prolapse of coil loops into parent artery after coils detached; the coil loops were successfully pushed back to aneurysm after stent placement. Two patients had difficulties to navigate the stents across the aneurysm necks because of tortuous parent arteries; in one of them, the stent partially covered the neck of aneurysm, which made the success of subsequent GDC embolization; in the other one, advancement of the stent to the targeted site was abortive, and the aneurysm was eventually loose packing. No significant procedure-related complication was found. One patient had asymptomatic dissection of the parent artery after stent placement. One patient had a transient ischemic attack and returned to normal baseline neurological conditions later. Clinical follow-up for these patients was 0.5 to 36 months, with a mean of 14 months. CONCLUSIONS: Stent-assisted embolization is a treatment of choice for wide neck aneurysms or for patient with herniation of coil loops to parent artery after coil detached. It was proven both safe and effective over a relatively long follow-up.

Kyphosis correction and height restoration effects of percutaneous vertebroplasty.

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty is known for its pain-relieving effect. Our purpose was to evaluate its effect on the kyphosis angle, wedge angle, and height of the fractured vertebral body. METHODS: We reviewed digital radiographs of 73 vertebral bodies in 53 patients before and after vertebroplasty. We measured the spinal kyphosis angle and the wedge angle of the fractured vertebral body. Ratios of the height of the anterior border, center, and posterior borders of the collapsed vertebra to the height at the posterior border of an adjacent normal vertebral body were measured. Gain from vertebroplasty and the restoration percentage (gain divided by loss) were calculated for each parameter. RESULTS: The kyphosis angle, wedge angle, anterior height, center height, and posterior height significantly improved after vertebroplasty. The mean reduction in the kyphosis angle was 4.3 degrees, and the wedge-angle reduction was 7.4 degrees. The mean wedge-angle reduction in fractured vertebral bodies containing gas was 10.2 degrees. Restoration percentages for the kyphosis angle and wedge angle were 19% and 44%, respectively. Gain in the height of the fractured vertebral bodies was 16.7% for the anterior border, 14% for the center, and 7% for the posterior border. Restoration percentages for the height of the vertebral body were 29% for the anterior border and 27% for the center. CONCLUSION: Vertebroplasty increases the height of the fractured vertebra and reduces the wedge and kyphosis angles. These effects are most remarkable in fractured vertebra containing gas.

Malignant renal epithelioid angiomyolipoma with aggressive behavior and distant metastasis.

Angiomyolipoma (AML) is a common renal tumor and mostly benign in entity. Malignant AML is extremely rare and most of them are found to be epithelioid AML histopathologically. We report the imaging features of a malignant epithelioid AML in a 58-year-old patient with liver and nodal metastases, and review the literatures. We have observed that AML of epithelioid subtype with tumoral necrosis may suggest the malignant change.

Congenital pelvic arteriovenous malformation: two cases and MR findings.

Congenital pelvic arteriovenous malformation (PAVM) is rare. We present two cases with emphasis on the imaging features. Magnetic resonance angiography (MRA) demonstrates comparable details of the vascular abnormalities as conventional angiography, which should be reserved for pre-embolization evaluation.

Tumor and tumor-like lesions of duodenum: CT and barium imaging features.

Neoplasms of the duodenum, either primary or secondary, are uncommon. However, imaging diagnosis for presurgical evaluation is extremely important due to complex regional anatomy. Computed tomography (CT) and barium-based double contrast examination (UGI series) are most frequently employed to evaluate the tumor invasion and intraluminal mucosal pattern. In this pictorial review, the CT and UGI series imaging features of benign and malignant duodenal tumors and tumor-like lesions are demonstrated and discussed.