Distinction between upper and lower gastrointestinal perforation: usefulness of the periportal free air sign on computed tomography.

PURPOSE: To evaluate the usefulness of the periportal free air (PPFA) sign on computed tomography (CT) to distinguish upper from lower gastrointestinal (GI) tract perforation. MATERIALS AND METHODS: During a 30-month period, we retrospectively analyzed abdominal CT images of 53 consecutive patients with surgically proven GI tract perforation. We divided the patients into two groups, i.e. upper and lower GI tract perforation groups. According to the distribution of free air, we divided the peritoneal cavity into supramesocolic compartment and inframesocolic compartment. We observed the presence or absence of free air in each compartment in each group. When there was free air in the periportal area, it was defined as periportal free air (PPFA) and the sign was positive. To evaluate the usefulness of the PPFA sign, we compared the PPFA sign with the falciform ligament sign and the ligamentum teres sign, both of which are well-known CT signs of pneumoperitoneum. Statistical analyses were performed with univariate and multivariate analyses using SPSS version 11.5 for significant findings among the CT signs. RESULTS: Free air was seen in supramesocolic compartment in 29 of 30 (97%) patients in the upper GI perforation group and in 17 of 23 (74%) in the lower GI perforation group. Free air in inframesocolic compartment did not show significant difference in either group (p=.16). The PPFA sign was seen in 28 of 30 (93%) patients with upper GI tract perforation, but in only 8 of 23 (35%) patients with lower GI tract perforation (p<.0001). The falciform ligament sign was seen in 24 of 30 (80%) patients with upper GI tract perforation and in 10 of 23 (43%) patients with lower GI tract perforation (p=.020). The ligamentum teres sign was seen in 16 of 30 (53%) patients with upper GI tract perforation and in 2 of 23 (8%) patients with lower GI tract perforation (p=.008). Multivariate logistic regression analysis showed that the PPFA sign was the only variable, which adjusted odds ratio of 15.5 (p=.002). CONCLUSION: The PPFA sign is a useful finding which can help to distinguish upper from lower GI tract perforation. When this sign is present, upper GI tract perforation is strongly suggested.

Abdominal extrapancreatic lesions associated with autoimmune pancreatitis: radiological findings and changes after therapy.

PURPOSE: To evaluate imaging findings of abdominal extrapancreatic lesions associated with autoimmune pancreatitis (AIP) and changes after steroid therapy. METHODS AND MATERIALS: This study included nine AIP patients with abdominal extrapancreatic lesions, which were determined by retrospective radiological review. CT (initial and follow-up, n=9) and MR imaging (initial, n=5) were reviewed by two radiologists in consensus to determine imaging characteristics (i.e., size, number, attenuation or signal intensity, and contrast enhancement of the lesions, and the presence of overlying capsule retraction) and evaluate changes with steroid therapy of abdominal extrapancreatic lesions associated with AIP. RESULTS: The most common abdominal extrapancreatic lesion associated with AIP was retroperitoneal fibrosis (RPF) in six patients. In five patients, CT and MR imaging revealed single or multiple, round- or wedge-shaped, hypoattenuating or hypointense, enhancing lesions in the renal cortex or pelvis. Other lesions included a geographic, ill-defined, hypoattenuating lesion with or without overlying capsule retraction in the liver in two and bile duct dilatation with or without bile duct wall thickening in four. Over a follow-up period of 6-81 months, CT exams of eight patients demonstrated partial or complete improvement of the abdominal extrapancreatic lesions, albeit their improvement in general lagged behind that of the pancreatic lesion. CONCLUSION: On CT or MR imaging, the abdominal extrapancreatic lesions associated with AIP are various in the retroperitoneum, liver, kidneys and bile ducts, and are reversible with steroid therapy.

Inflammation-specific T1 imaging using anti-intercellular adhesion molecule 1 antibody-conjugated gadolinium diethylenetriaminepentaacetic acid.

To examine inflammatory tissue, an initial and common symptom of various types of pathogenesis, we designed inflammation-targeted T(1) contrast agents prepared by bioconjugation of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) with anti-intercellular adhesion molecule 1 (ICAM-1) antibody. The anti-ICAM-1 antibody was coupled with DTPA and was then conjugated with Gd. The specific binding of the Gd-DTPA-anti-ICAM-1 antibody complex to the ICAM-1-expressing cells was examined in the cultured endothelial cells where ICAM-1 expression was stimulated. Inflammation-specific T(1) imaging was then assessed using a mouse abscess model with the 1.5-Tesla module. The Gd-DTPA-anti-ICAM-1 antibody displayed increased r1, which was two times higher than that of Gd-DTPA and showed predominant binding to cultured endothelial cells, which expressed a high level of ICAM-1. Moreover, the inflammation-specific T(1) enhancement was imaged with the Gd-DTPA-anti-ICAM-1 antibody in the mouse acute inflammation model. The Gd-DTPA-anti-ICAM-1 antibody showed significantly increased vascular circulation time, which thereby offered a greater chance for its binding to the target cells. The Gd-DTPA-anti-ICAM-1 antibody displays a potential targeted T(1) contrast agent specific to the inflammatory tissue that expresses ICAM-1.

Peliosis hepatis with hemorrhagic necrosis and rupture: a case report with emphasis on the multi-detector CT findings.

We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy. We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.

Hepatic parasitic abscess caused by clonorchiasis: unusual CT findings of clonorchiasis.

Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.

Compact soft x-ray transmission microscopy with sub-50 nm spatial resolution.

In this paper, the development of compact transmission soft x-ray microscopy (XM) with sub-50 nm spatial resolution for biomedical applications is described. The compact transmission soft x-ray microscope operates at lambda = 2.88 nm (430 eV) and is based on a tabletop regenerative x-ray source in combination with a tandem ellipsoidal condenser mirror for sample illumination, an objective micro zone plate and a thinned back-illuminated charge coupled device to record an x-ray image. The new, compact x-ray microscope system requires the fabrication of proper x-ray optical devices in order to obtain high-quality images. For an application-oriented microscope, the alignment procedure is fully automated via computer control through a graphic user interface. In imaging studies using our compact XM system, a gold mesh image was obtained with 45 nm resolution at x580 magnification and 1 min exposure. Images of a biological sample (Coscinodiscus oculoides) were recorded.

Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment.

PURPOSE: To determine prospectively the diagnostic performance of unenhanced computed tomography (CT) in the assessment of macrovesicular steatosis in potential donors for living donor liver transplantation by using same-day biopsy as a reference standard. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. A total of 154 candidates, including 104 men (mean age, 30.2 years +/- 10.3 [standard deviation]) and 50 women (mean age, 31.8 years +/- 11.2), underwent same-day unenhanced CT and ultrasonography-guided liver biopsy. Histologic degree of macrovesicular steatosis was determined. Three liver attenuation indices were derived: liver-to-spleen attenuation ratio (CT(L)(/S)), difference between hepatic and splenic attenuation (CT(L)(-S)), and blood-free hepatic parenchymal attenuation (CT(LP)). Regression equations were used to quantitatively estimate the degree of macrovesicular steatosis. Limits of agreement between estimated macrovesicular steatosis and the reference standard were calculated. Receiver operating characteristic analyses were used to determine the performance of each index for qualitative diagnosis of macrovesicular steatosis of 30% or greater. The cutoff value that provided a balance between sensitivity and specificity and the highest cutoff value that yielded 100% specificity were determined. RESULTS: Limits of agreement were -14% to 14% for CT(L)(/S) and CT(L)(-S) and -13% to 13% for CT(LP). Performance in diagnosing macrovesicular steatosis of 30% or greater was not significantly different among indices (P > .05). Cutoff values of 0.9, -7, and 58 were determined for CT(L)(/S), CT(L)(-S), and CT(LP), respectively, and provided a balance between sensitivity and specificity. Cutoff values of 0.8, -9, and 42 were determined for CT(L)(/S), CT(L)(-S), and CT(LP), respectively, and yielded 100% specificity for all indices, with corresponding sensitivities of 82%, 82%, and 73% for CT(L)(/S), CT(L)(-S), and CT(LP), respectively. CONCLUSION: Diagnostic performance of unenhanced CT for quantitative assessment of macrovesicular steatosis is not clinically acceptable. Unenhanced CT, however, provides high performance in qualitative diagnosis of macrovesicular steatosis of 30% or greater.

Contrast-enhancing hepatic eosinophilic abscess during the hepatic arterial phase: a mimic of hepatocellular carcinoma.

OBJECTIVE: Our objective was to review CT, MR, angiographic, and sonographic images obtained in patients with histopathologically proven contrast-enhancing hepatic eosinophilic abscesses during the hepatic arterial phase. CONCLUSION: On CT, MR, and angiographic images, eosinophilic abscess in the liver can show contrast enhancement during the hepatic arterial phase. If patients have peripheral hypereosinophilia or are at low risk for hepatocellular carcinoma or hepatic metastasis, those with small arterial-enhancing hepatic nodules need further preoperative evaluation, such as a sonographically guided biopsy.