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Han X, Yang D, Su Y, Wang Q, Li M, Du N, Jiang J, Tian X, Liu J, Jia J, Yang Z, Zhao X, Ma H. Identification of abdominal MRI features associated with histopathological severity and treatment response in autoimmune hepatitis. Eur Radiol 2025:10.1007/s00330-025-11578-1. [PMID: 40278875 DOI: 10.1007/s00330-025-11578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 02/16/2025] [Accepted: 03/13/2025] [Indexed: 04/26/2025]
Abstract
To identify abdominal contrast magnetic resonance imaging (MRI) features associated with histopathological severity, and treatment response in autoimmune hepatitis (AIH). PATIENTS AND METHODS AIH patients who had abdominal contrast MRI within 3 months of liver biopsy were retrospectively enrolled. Histopathological severity, liver volume, MRI features, laboratory tests, and treatment response were collected. MRI and serum models were constructed through stepwise univariate and multivariate logistic regression for diagnosing severe histopathology and predicting insufficient response (IR). RESULTS One hundred AIH patients were included (median age: 57.0 years, 79.0% female). For diagnosing severe portal inflammation, reticular fibrosis and volume ratio of segment V-VIII to total liver (SV-SVIII/TLV) achieved an area under the receiver operating characteristic curve (AUROC) of 0.765 (95% CI 0.670-0.860). Severe confluent necrosis was modeled using hepatic fissure widening, reticular fibrosis, and volume ratio of segment I-III to segments IV-VIII, achieving an AUROC of 0.796 (95% CI 0.708-0.885). Severe histological activity was modeled using ascites, and SV-SVIII/TLV achieved an AUROC of 0.748 (95% CI 0.649-0.847). To diagnose cirrhosis, ascites, reticular fibrosis, and the volume ratio of segment I to the total liver were employed, yielding an AUROC of 0.833 (95% CI 0.716-0.949); IR (transaminases and/or immunoglobulin G remaining unnormal after 6 months of immunosuppressive treatment) was modeled using ascites, gallbladder wall edema, and transient hepatic attenuation difference, achieving an AUROC of 0.796 (95% CI 0.691-0.902). CONCLUSION The MRI models demonstrated relatively good performance in evaluating histopathological severity and treatment response. Combining MRI and serum models could enhance diagnostic and prognostic efficacy. KEY POINTS Question Abdominal contrast MRI may help clinicians better evaluate the histopathological severity and treatment response of autoimmune hepatitis (AIH), but there is currently limited research. Findings Models based on MRI features perform well in diagnosing severe portal inflammation, confluent necrosis, histological activity, and cirrhosis, as well as predicting insufficient response. Clinical relevance Abdominal contrast MRI, combined with serological parameters, provides a new and stronger noninvasive method for clinically assessing AIH progression and treatment.
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Affiliation(s)
- Xiao Han
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yu Su
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qianyi Wang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Min Li
- Department of Clinical Epidemiology and Evidence Base Medicine Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Nianhao Du
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiahui Jiang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xin Tian
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jimin Liu
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Xinyan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Hong Ma
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Nakamura Y, Kuwahara M, Ito K, Inagaki F, Mihara F, Takemura N, Kokudo N. Percutaneous Transhepatic Gallbladder Intervention as a Bridge to Cholecystectomy: Aspiration or Drainage? World J Surg 2023; 47:1721-1728. [PMID: 37000200 DOI: 10.1007/s00268-023-06987-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Percutaneous transhepatic gallbladder aspiration (PTGBA) and percutaneous transhepatic gallbladder drainage (PTGBD) are often the first-line treatments for acute cholecystitis, instead of surgical cholecystectomy. This retrospective study aimed to compare the treatment outcomes of PTGBA and PTGBD and evaluate the risks of treatment failure among patients undergoing PTGBA before surgical cholecystectomy. METHODS We retrospectively reviewed 99 patients who underwent PTGBA or PTGBD as the first-line treatment before surgical cholecystectomy, between January 2014 and December 2019. Patient characteristics, computed tomography (CT) findings, and post-treatment outcomes were compared between the PTGBA and PTGBD groups. Additionally, risk factors, including CT findings for PTGBA failure, were assessed using multivariate univariate analysis with a backward selection model. RESULTS Acute cholecystitis was not controlled in 21 of 47 (44.7%) patients in the PTGBA group and one of 52 patients (1.9%) in the PTGBD group (P < .001). Subsequent multiple logistic regression analysis identified the contrast effect of the gallbladder bed in the arterial phase of contrast-enhanced CT (odds ratio [OR] 9.17, 95% confidence interval [CI] 2.08-40.4, P = 0.003) and onset within 3 days (odds ratio [OR] 6.29, 95% confidence interval [CI] 1.37-29.0, P = 0.018) as independent risk factors for PTGBA failure. CONCLUSIONS PTGBA is more prone to failure than PTGBD; however, it is a simpler gallbladder drainage treatment method without the need for X-ray fluoroscopy and catheter management after the procedure. Evaluating the risk of PTGBA failure using CT findings and onset date would help us choose a drainage approach more effectively.
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Affiliation(s)
- Yuki Nakamura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Mai Kuwahara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan.
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
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Correlation Between Computed Tomography Findings and the Laboratory Test-Derived Severity Score in Patients With Severe Acute Alcoholic Hepatitis. J Comput Assist Tomogr 2023:00004728-990000000-00153. [PMID: 36877790 DOI: 10.1097/rct.0000000000001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE This study aimed to compare computed tomography (CT) findings between patients with severe and nonsevere acute alcoholic hepatitis (AAH). METHODS We included 96 patients diagnosed with AAH between January 2011 and October 2021 who underwent 4-phase liver CT and laboratory blood tests. Two radiologists reviewed the initial CT images with respect to distribution and grade of hepatic steatosis; transient parenchymal arterial enhancement (TPAE); and presence of cirrhosis, ascites, and hepatosplenomegaly. A Maddrey discriminant function score (4.6 × [patient's prothrombin time - control] + total bilirubin [mg/mL]) was used as cutoff indicator for severity, with a score of 32 or higher indicating severe disease. The image findings were compared between the severe (n = 24) and nonsevere (n = 72) groups using the χ2 test or Fisher exact test. After univariate analysis, the most significant factor was identified using a logistic regression analysis. RESULTS In the univariate analysis, there were significant between-group differences in the TPAE, liver cirrhosis, splenomegaly, and ascites (P < 0.0001, P < 0.0001, P = 0.0002, and P = 0.0163, respectively). Among them, TPAE was the only significant factor for severe AAH (P < 0.0001; odds ratio, 48.1; 95% confidence interval, 8.3-280.6). Using this single indicator, the estimated accuracy, positive predictive, and negative predictive values were 86%, 67%, and 97%, respectively. CONCLUSIONS Transient parenchymal arterial enhancement was the only significant CT finding in severe AAH.
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Lesion or Pseudolesion? A Comprehensive Description of Perfusion-Based Liver Alterations on Contrast-Enhanced Computed Tomography and Literature Review. J Comput Assist Tomogr 2023; 47:9-23. [PMID: 36584106 DOI: 10.1097/rct.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Pseudolesions on contrast-enhanced computed tomography represent a diagnostic challenge for radiologists because they could be difficult to distinguish from true space-occupying lesions. This article aims to provide a detailed overview of these entities based on radiological criteria (hyperattenuation or hypoattenuation, localization, morphology), as well as a brief review of the hepatic vascular anatomy and pathophysiological process. Relevant examples from hospital case series are reported as helpful hints to assist radiologists in recognizing and correctly diagnosing these abnormalities.
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Lin M, Cao L, Wang J, Zhou J. Diagnosis of hepatic inflammatory pseudotumor by fine-needle biopsy. J Interv Med 2022; 5:166-170. [PMID: 36317142 PMCID: PMC9617152 DOI: 10.1016/j.jimed.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022] Open
Abstract
Hepatic inflammatory pseudotumor (IPT) is a benign lesion characterized by chronic infiltration of inflammatory cells and fibrosis that clinically, radiologically, and pathologically mimics malignancy. However, the epidemiology of IPTs remains unclear. IPTs are often misdiagnosed as malignant lesions because of the lack of characteristic features. We present the case of a 32-year-old man that was misdiagnosed as intrahepatic cholangiocarcinoma by CECT, CEMRI, and CEUS, which was finally confirmed as IPT by fine-needle liver biopsy. In this report, the key factor in the diagnosis of liver inflammatory masses was the presence of hepatic perfusion disorder.
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Huda F, LeBedis CA, Qureshi MM, Anderson SW, Gupta A. Acute cholecystitis: diagnostic value of dual-energy CT-derived iodine map and low-keV virtual monoenergetic images. Abdom Radiol (NY) 2021; 46:5125-5133. [PMID: 34223959 DOI: 10.1007/s00261-021-03202-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare conventional and dual-energy CT (DECT) for the diagnosis of acute cholecystitis and gangrene. METHODS Fifty-seven consecutive adult patients with abdominal pain who underwent IV contrast-enhanced abdominal DECT on a dual-layer (dlDECT) or rapid-switching (rsDECT) scanner from September, 2018 to April, 2021 with cholecystectomy and pathology-confirmed cholecystitis were retrospectively reviewed, and compared with 57 consecutive adult patients without cholecystitis from the same interval scanned with DECT. Images were reviewed independently by two abdominal radiologists with 12 and 16 years of experience in two sessions 4 weeks apart, blinded to clinical data. Initially, only blended reconstructions (simulating conventional single-energy CT images) were reviewed (CT). Subsequently, CT and DECT reconstructions including low-keV virtual monoenergetic images and iodine maps were reviewed. Gallbladder fossa hyperemia, pericholecystic fluid, subjective presence of gangrene, heterogeneous wall enhancement, sloughed membranes, intramural air, abscess, overall impression of the presence of acute cholecystitis, and intramural iodine density were assessed. RESULTS Gallbladder fossa hyperemia was detected with increased sensitivity on DECT (R1, 61.4%; R2, 75.4%) vs. CT (R1, 22.8%; R2, 15.8%). DECT showed increased sensitivity for gangrene (R1, 24.6%; R2, 38.6%) vs. CT (R1, 5.3%; R2, 14%), heterogeneous wall enhancement (DECT: R1, 33.3%; R2, 63.2% vs. CT: R1, 7%; R2, 31.6%), and cholecystitis (DECT: R1, 86%; R2, 89.5% vs. CT: R1, 77.2%; R2, 70.2%). In addition, DECT was more sensitive for the detection of acute cholecystitis (R1, 86%; R2, 89.5%) vs. CT (R1, 77.2%; R2, 70.2%). Iodine density threshold of 1.2 mg/ml, 0.8 mg/mL, and 0.5 mg/mL showed specificity for gangrenous cholecystitis of 78.26%, 86.96%, and 95.65%, respectively, using the rsDECT platform. CONCLUSION DECT showed improved sensitivity compared to conventional CT for detection of acute cholecystitis. Iodine density measurements may be helpful to diagnose gangrene.
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Erlichman DB, Lipman JN, In H, Ye K, Lin J, Goldman I. Diagnostic significance of the CT rim sign in cases of gangrenous cholecystitis. Clin Imaging 2020; 73:53-56. [PMID: 33310404 DOI: 10.1016/j.clinimag.2020.11.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/05/2020] [Accepted: 11/21/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the association between the CT rim sign and gangrenous cholecystitis (GC) and increased surgical difficulty. METHOD Patients who had a contrast enhanced CT of the abdomen and pelvis, followed by non-elective cholecystectomy were analyzed. The scans were reviewed for the CT rim sign by radiologists blinded to the pathologic and clinical outcomes. Demographic and clinical characteristics were compared between patients with and without GC using t-tests or Wilcoxon ranked sum test for continuous variables, and Fishers' exact test for categorical variables, when appropriate. A logistic regression model was fitted with multiple risk factors. Odds ratios as well as 95% confidence intervals were then calculated for the risk factors. A secondary analysis predicting increased surgical difficulty, defined as an operative time of greater than 2 h or increased conversion rate to open surgery, was also examined. RESULTS A total of 100 patients were included; 20 of which had GC. On imaging, patients with GC were more likely to have a CT rim sign (65% vs 32.5%, OR = 3.80, 95% CI: 1.24-12.7, p = 0.011). The presence of the CT rim sign did not reach a statistically significant association with an operative time >2 h or conversion to open case (56.52% vs 33.77%, OR = 2.55, p = 0.056). CONCLUSION The CT rim sign can be utilized to raise the possibility of GC, however the presence of the CT rim sign does not demonstrate an association with increased surgical difficulty.
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Affiliation(s)
- David B Erlichman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America.
| | - Jeffrey N Lipman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Haejin In
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kenny Ye
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Juan Lin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Inessa Goldman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
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Yang B, Si G, He Q, Liu S, Wang S, Xian R, Zhang J, Yu F, Guan J. Multislice Computed Tomographic Manifestation of Transient Hepatic Attenuation Difference in the Left Lobe of the Liver: A Retrospective Study. Adv Ther 2020; 37:3954-3966. [PMID: 32715380 DOI: 10.1007/s12325-020-01428-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Transient hepatic attenuation differences (THAD) are areas of high parenchymal enhancement observed during the hepatic arterial phase on computed tomography (CT). THAD in the left lobe of the liver can lead to surgical complications. METHODS A retrospective study was conducted on patients who underwent multislice computed tomography (MSCT) examination of the upper abdomen to understand the morphology, distribution, and causes of THAD and their correlation with hepatic artery variation. RESULTS Among 179 cases, 65 and 114 belonged to diseased and normal groups, respectively. THAD as observed in MSCT demonstrated various shapes: lobe/segment (127 cases; 70.9%), irregular sheet (31; 17.3%), strip shape (9; 5.02%), arc/semicircle (7; 3.9%), and segment + flaky (5; 2.79%). THAD were found to be caused by liver tumor (32.3%), hepatic inflammatory lesions (6.15%), biliary tract diseases (13.8%), perihepatic disease compression (9.23%), portal vein obstructive disease (1.53%), and lesion in left hepatic lobe with hepatic artery variation (29.2%). THAD exhibited variation in distribution in the left lobe of the liver. Among 114 cases, THAD in 18 (15.7%) cases were observed in the S2 segment, six (5.26%) in the S3 segment, and 90 (78.9%) in multiple segments of the liver, that is, 50 cases in S2 and S3 segments and 40 cases in S2, S3, and S4 segments. The hepatic artery of 179 cases was of various types based on Hiatt classification: 57 cases of Hiatt I (31%), 65 cases of Hiatt II (37%), 11 cases of Hiatt III (6%), 17 cases of Hiatt IV (10%), 7 cases of Hiatt V (4%), 12 cases of large left hepatic artery (7%), 6 cases of right hepatic artery originating from the celiac trunk (3%), and 4 cases (2%) of superior mesenteric artery originating from the celiac trunk. CONCLUSION THAD can occur as a result of specific pathological causes and hence should be considered as a diagnostic sign in liver pathologies.
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Affiliation(s)
- Bin Yang
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Guangyan Si
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China.
| | - Qizhou He
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Shulan Liu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Sikai Wang
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Rong Xian
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Jie Zhang
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Fei Yu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital of Zhongshan University, Guang Zhou, 510080, Guangdong, People's Republic of China
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A pictorial review of gall stones and its associated complications. Clin Imaging 2020; 60:228-236. [DOI: 10.1016/j.clinimag.2019.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/13/2019] [Accepted: 11/04/2019] [Indexed: 01/11/2023]
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Wang Q, Koniaris LG, Milgrom DP, Patel A, Hu M, Cui E, Deng Y, Akisik F. CT and MRI imaging and interpretation of hepatic arterioportal shunts. Transl Gastroenterol Hepatol 2019; 4:34. [PMID: 31231701 DOI: 10.21037/tgh.2019.05.05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/08/2019] [Indexed: 12/31/2022] Open
Abstract
Hepatic arterioportal shunts (HAPS) occur due to organic or functional fistulization of blood flow between arterial hepatic vasculature and venous portal systems. It is a type of hemodynamic abnormality of the liver being observed increasingly with the use of temporal imaging modalities. HAPS occur due to other underlying hepatic abnormalities including the presence of an underlying tumor or malignancy. When a HAPS is present, the appearance of these abnormalities on imaging studies suggests an underlying abnormality, must be considered atypical even if asymptomatic, and warrants careful evaluation. Over time, and as a function of degree of fistulae, symptoms and potential life-threatening complications may arise from the HAPS. These systemic complications may include the development of portal hypertension, splenomegaly, as well as accelerated metastasis in patients with malignant tumors. This manuscript reviews common underlying conditions associated with HAPS and their radiologic interpretation.
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Affiliation(s)
- Qiushi Wang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.,Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leonidas G Koniaris
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel P Milgrom
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aash Patel
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maoqing Hu
- Department of Radiology, Jiangmen Central Hospital, Jiangmen 529030, China
| | - Enming Cui
- Department of Radiology, Jiangmen Central Hospital, Jiangmen 529030, China
| | - Yu Deng
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Fatih Akisik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
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The hot rim sign. Abdom Radiol (NY) 2018; 43:3530-3531. [PMID: 29869101 DOI: 10.1007/s00261-018-1655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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The utility of hepatic artery velocity in diagnosing patients with acute cholecystitis. Abdom Radiol (NY) 2018; 43:1159-1167. [PMID: 28840272 DOI: 10.1007/s00261-017-1288-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To test the diagnostic performance of elevated peak systolic hepatic arterial velocity (HAv) in the diagnosis of acute cholecystitis. METHODS 229 patients with an ultrasound (US) performed for right upper quadrant (RUQ) pain were retrospectively reviewed. 35 had cholecystectomy within 10 days of ultrasound and were included as test subjects. 47 had normal US and serology and were included as controls. Each test patient US was reviewed for the presence of gallstones, gallbladder distention, sludge, echogenic pericholecystic fat, pericholecystic fluid, gallbladder wall thickening, gallbladder wall hyperemia, and reported sonographic Murphy sign. Demographic, clinical, and hepatic artery parameters at time of original imaging were recorded. Acute cholecystitis at pathology was the primary outcome variable. RESULTS 21 patients had acute cholecystitis and 14 had chronic cholecystitis by pathology. For patients who went to cholecystectomy, HAv ≥100 cm/s to diagnose acute cholecystitis was more accurate (69%) than the original radiology report (63%), the presence of gallstones (51%), and sonographic Murphy sign (50%). Statistically significant predictors of acute cholecystitis included HAv ≥100 cm/s (p = 0.008), older age (p = 0.012), and elevated WBC (p = 0.002), while gallstones (p = 0.077), hepatic artery resistive index (HARI) (p = 0.199), gallbladder distension (p = 0.252), sludge (p = 0.147), echogenic fat (p = 0.184), pericholecystic fluid (p = 0.357), wall thickening (p = 0.434), hyperemia (p = 0.999), and sonographic Murphy sign (p = 0.765) were not significantly correlated with acute cholecystitis compared to chronic cholecystitis. CONCLUSION HAv ≥100 cm/s is a useful objective parameter that may improve the performance of US in the diagnosis of acute cholecystitis.
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Prediction of difficult laparoscopic cholecystectomy for acute cholecystitis. J Surg Res 2017; 216:143-148. [DOI: 10.1016/j.jss.2017.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/18/2017] [Accepted: 05/02/2017] [Indexed: 12/07/2022]
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Scrub typhus: radiological and clinical findings in abdominopelvic involvement. Jpn J Radiol 2017; 35:101-108. [DOI: 10.1007/s11604-016-0607-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/20/2016] [Indexed: 01/10/2023]
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Chawla A, Bosco JI, Lim TC, Srinivasan S, Teh HS, Shenoy JN. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting. Singapore Med J 2016; 56:438-43; quiz 444. [PMID: 26311909 DOI: 10.11622/smedj.2015120] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgical planning. Imaging features of acute cholecystitis have been described in the literature and are variable, depending on the stage of inflammation. This article discusses the spectrum of cholecystitis-associated complications and their imaging manifestations. We also suggest a checklist for the prompt and accurate identification of complications in acute cholecystitis.
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Affiliation(s)
- Ashish Chawla
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Jerome Irai Bosco
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Tze Chwan Lim
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | | | - Hui Seong Teh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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Maehira H, Itoh A, Kawasaki M, Ogawa M, Imagawa A, Mizumura N, Okumura S, Kameyama M. Use of dynamic CT attenuation value for diagnosis of acute gangrenous cholecystitis. Am J Emerg Med 2016; 34:2306-2309. [PMID: 27569745 DOI: 10.1016/j.ajem.2016.08.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 08/12/2016] [Accepted: 08/13/2016] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVE To determine if the increase in transient focal enhancement of the liver adjacent to the gallbladder seen on dynamic computed tomography (CT) is greater in gangrenous cholecystitis than in nongangrenous cholecystitis by determining the CT attenuation value. METHODS We retrospectively reviewed the medical records of 57 patients who underwent emergency cholecystectomy for acute cholecystitis and preoperative dynamic CT scans between March 2011 and April 2016. Based on the pathology findings, patients were assigned to a gangrenous group or a nongangrenous group. The CT attenuation ratio (AR) was defined as the ratio of the maximum CT attenuation value in the region of interest in segment 5 (liver parenchyma adjacent to the gallbladder) and that in the control region of interest in segment 8. The patient characteristics and CT findings were compared between the groups. The appropriate AR of the arterial phase (ARAP) cutoff value for a diagnosis of gangrenous cholecystitis was determined using receiver operating characteristic curve analysis. RESULTS The ARAP was significantly higher in the gangrenous group than in the nongangrenous group (P < .001); the area under the receiver operating characteristic curve was 0.849. The ARAP cutoff value of 1.46 had a sensitivity and specificity of 84.6% and 83.9%, respectively (odds ratio, 21.17; 95% confidence interval, 4.90-118.91), and ARAP ≥1.46 was significantly correlated with a diagnosis of gangrenous cholecystitis (P < .001). CONCLUSIONS The increase in transient focal enhancement of the liver adjacent to the gallbladder during the arterial phase of dynamic CT was greater in gangrenous cholecystitis than in nongangrenous cholecystitis.
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Affiliation(s)
| | - Aya Itoh
- Department of Surgery, Bell Land General Hospital, Osaka, Japan
| | | | - Masao Ogawa
- Department of Surgery, Bell Land General Hospital, Osaka, Japan
| | - Atsuo Imagawa
- Department of Surgery, Bell Land General Hospital, Osaka, Japan
| | - Naoto Mizumura
- Department of Surgery, Bell Land General Hospital, Osaka, Japan
| | - Satoshi Okumura
- Department of Surgery, Bell Land General Hospital, Osaka, Japan
| | - Masao Kameyama
- Department of Surgery, Bell Land General Hospital, Osaka, Japan
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Kim JE, Choi DS, Bae K, Cho JM, Jeong CY, Kim HO. Added value of point shear-wave elastography in the diagnosis of acute cholecystitis. Eur Radiol 2016; 27:1517-1526. [PMID: 27510624 DOI: 10.1007/s00330-016-4509-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the added value of point shear-wave elastography (pSWE) in the diagnostic performance of conventional US for diagnosis of acute cholecystitis. METHODS B-mode and colour Doppler US and pSWE were performed prospectively in 216 patients with clinically suspected acute cholecystitis. The morphology and mural vascularity of the gallbladder and median shear wave velocity (SWV) of the right liver were evaluated. Two observers independently reviewed conventional US images and subsequently reviewed combined conventional US and pSWE images. RESULTS Mean SWVs of the acute cholecystitis group (n = 91) were significantly higher than those of the control group (n = 85) in the right liver within 2 cm lateral to the gallbladder (1.56 versus 1.03 m/s, 1.39 versus 1.04 m/s, P < 0.0001) with a cut-off value of 1.29 or 1.16 m/s. The area under the receiver operating characteristic curve of both observers in the diagnosis of acute cholecystitis improved significantly from 0.790 and 0.777 to 0.963 and 0.962, respectively, after additional review of pSWE images (P < 0.0001). Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of combined image sets were higher than those of conventional US images alone. CONCLUSION Adding pSWE to conventional US improves the diagnosis of acute cholecystitis when compared with conventional US alone. KEY POINTS • In acute cholecystitis, stiffness of the right liver increases adjacent to the gallbladder. • The cut-off value for diagnosing acute cholecystitis was 1.29 or 1.16 m/s. • Adding pSWE to conventional US improves the diagnosis of acute cholecystitis.
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Affiliation(s)
- Ji Eun Kim
- Department of Radiology, Gyeongsang National University School of medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University School of medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.
| | - Kyungsoo Bae
- Department of Radiology, Gyeongsang National University School of medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Jae Min Cho
- Department of Radiology, Gyeongsang National University School of medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Chi Young Jeong
- Department of Surgery, Gyeongsang National University School of medicine, Jinju, Republic of Korea
| | - Hyun Ok Kim
- Department of Internal medicine, Gyeongsang National University School of medicine, Jinju, Republic of Korea
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Kawai R, Hata J, Manabe N, Imamura H, Iida A, Koyama N, Kusunoki H. Increased enhancement of the liver adjacent to the gallbladder seen with contrast ultrasound: comparison between acute cholecystitis and non-cholecystitis. BMC Med Imaging 2016; 16:21. [PMID: 26965715 PMCID: PMC4785724 DOI: 10.1186/s12880-016-0115-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/22/2016] [Indexed: 11/12/2022] Open
Abstract
Background This study was performed to evaluate the ability of contrast-enhanced ultrasonography (CEUS) with time-intensity curve analysis to demonstrate an increased enhancement of the liver parenchyma adjacent to the inflamed gallbladder, as seen on contrast-enhanced computed tomography. Methods The Ethics Committee of our institution approved the study protocol (Kawasaki Medical School, registration number 1277). From April to November 2013, 11 consecutive patients with acute cholecystitis and 16 patients without cholecystitis consented to CEUS (Sonazoid™) and were enrolled in this study. The gallbladder and liver were scanned by one gastroenterologist using harmonic imaging with a low mechanical index. The raw imaging data were stored. Another physician, blinded to all clinical information, constructed the time-intensity curve. The major axis of the region of interest (ROI) was set in segment 5 (pericholecystic area), and the control ROI in segment 8 at the same depth. The intensity ratio (IR) was defined as the peak intensity of segment 5 divided by the simultaneous value of segment 8. The characteristics of the patient with and without acute cholecystitis were compared. The correlation between the IR and the presence of acute cholecystitis was analyzed using binomial logistic regression analysis. A receiver operating characteristic (ROC) curve analysis was performed as well. Results The IR was significantly higher in the group with than without acute cholecystitis (p = 0.006). The IR correlated significantly with the presence of acute gallbladder inflammation (p = 0.043). The area under the ROC curve was estimated as 0.852 (95 % confidence interval, 0.709–0.995). A cut-off value of 2.72 had a sensitivity of 81.8 % and a specificity of 81.3 %. Conclusions The IR obtained by CEUS with time-intensity curve analysis generally demonstrated increased enhancement of the liver parenchyma adjacent to the inflamed gallbladder.
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Affiliation(s)
- Ryousuke Kawai
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Jiro Hata
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Noriaki Manabe
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Hiroshi Imamura
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Ai Iida
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Nobuko Koyama
- Department of Hepatology and Pancreatology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Hiroaki Kusunoki
- Department of General Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
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Montini KM, Tulchinsky M. Applied hepatobiliary scintigraphy in acute cholecystitis. APPLIED RADIOLOGY 2015:21-30. [DOI: 10.37549/ar2183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
| | - Mark Tulchinsky
- Pennsylvania State University, The Milton S. Hershey Medical Center
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21
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Makara M, Chau J, Hall E, Kloeppel H, Podadera J, Barrs V. EFFECTS OF TWO CONTRAST INJECTION PROTOCOLS ON FELINE AORTIC AND HEPATIC ENHANCEMENT USING DYNAMIC COMPUTED TOMOGRAPHY. Vet Radiol Ultrasound 2015; 56:367-73. [PMID: 25640846 DOI: 10.1111/vru.12239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 11/19/2014] [Indexed: 11/28/2022] Open
Abstract
This prospective study compared aortic and hepatic enhancement achieved using a contrast injection protocol with a fixed rate of 5 ml/s vs. that achieved using a protocol with fixed injection duration of 20 s in eight cats. Cats were assigned into two groups (Group 1, rate 5 ml/s; Group 2, duration 20 s). The dose of contrast was the same in both groups (740 mgI/kg). Regions of interest (ROI) were drawn in the aorta and liver for transverse scans acquired at the hepatic hilus. Time to peak aortic enhancement occurred significantly earlier in Group 1 (M = 11s, SD = 1.63) than in Group 2 (M = 25.5 s, SD = 2.51). Peak aortic enhancement was significantly higher in Group 1 (M = 1906.51 HU, SD = 368.64) than in Group 2 (M = 745.08 HU, SD = 201.84). Duration of aortic enhancement equal to or above 300 HU was statistically longer in Group 2 (M = 24.5 s, SD = 8.39) than in Group 1 (M = 10 s, SD = 1.63). There were no significant differences in time to peak liver enhancement, peak liver enhancement, or duration of hepatic arterial phase between groups. Findings supported the hypothesis that longer injection duration results in a broader bolus geometry with a longer time to peak and a lower peak aortic enhancement in cat. This strong influence of injection duration on timing of aortic enhancement may help future users optimize protocols for CT angiography of the aorta and multiphasic evaluation of the liver, pancreas, and small intestine.
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Affiliation(s)
- Mariano Makara
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Jennifer Chau
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Evelyn Hall
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Heide Kloeppel
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Juan Podadera
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Vanessa Barrs
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
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Bennett GL. Cholelithiasis, Cholecystitis, Choledocholithiasis, and Hyperplastic Cholecystoses. TEXTBOOK OF GASTROINTESTINAL RADIOLOGY, 2-VOLUME SET 2015:1348-1391. [DOI: 10.1016/b978-1-4557-5117-4.00077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Tang W, Zhang XM, Zhai ZH, Zeng NL. Hepatic abnormal perfusion visible by magnetic resonance imaging in acute pancreatitis. World J Radiol 2013; 5:491-497. [PMID: 24379936 PMCID: PMC3874506 DOI: 10.4329/wjr.v5.i12.491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/26/2013] [Accepted: 11/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To study the prevalence and patterns of hepatic abnormal perfusion (HAP) visible by magnetic resonance imaging (MRI) in acute pancreatitis (AP). METHODS Enhanced abdominal MRI was performed on 51 patients with AP. These patients were divided into two groups according to the MRI results: those with signs of gallstones, cholecystitis, common bile duct (CBD) stones or dilatation of the CBD on MRI and those without. The prevalence, shape and distribution of HAP in the two groups were analyzed and compared. The severity of AP was graded using the MR severity index (MRSI). The correlation between the MRSI and HAP was then analyzed. RESULTS Of the 51 patients with AP, 32 (63%) showed at least one sign of gallbladder and CBD abnormalities on the MR images, while 19 (37%) showed no sign of gallbladder or CBD abnormalities. Nineteen patients (37%) had HAP visible in the enhanced images, including strip-, wedge- or patch-shaped HAP distributed in the hepatic tissue adjacent to the gallbladder and left and right liver lobes. There were no significant differences in the prevalence of HAP (χ (2) = 0.305, P = 0.581 > 0.05) or HAP distribution in the liver (χ (2) = 2.181, P = 0.536 > 0.05) between patients with and without gallbladder and CBD abnormalities. There were no significant differences in the MRSI score between patients with and without HAP (t = 0.559, P = 0.552 > 0.05). HAP was not correlated with the MRSI score. CONCLUSION HAP is common in patients with AP and appears strip-, patch- or wedge-shaped on MRI. HAP on MRI cannot be used to indicate the severity of AP.
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Patel NB, Oto A, Thomas S. Multidetector CT of Emergent Biliary Pathologic Conditions. Radiographics 2013; 33:1867-88. [DOI: 10.1148/rg.337125038] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Acute cholecystitis (AC) and lower-gastrointestinal (GI) bleeding are 2 emergencies commonly encountered in nuclear medicine. Evidence of AC on hepatobiliary scintigraphy (HBS) allows for confident diagnosis and provides support for definitive surgical treatment. Proper patient preparation is essential for HBS including fasting and the use of pharmacologic adjuncts is sometimes required. Pharmacologic adjuncts may also be administered during HBS to shorten the length of the examination and increase its specificity. In the interpretation of HBS, there are several sources of false-positive results to be aware of, most commonly chronic cholecystitis. False-negative results on HBS are usually the result of mistaking another structure, such as a dilated cystic duct, for the gallbladder. Abdominal ultrasound is the appropriate initial test in patients with suspected AC, but HBS is an excellent second tier test for the diagnosis of AC in the work-up of indeterminate cases by sonography. GI bleeding scintigraphy plays an important role in the evaluation and management of patients with acute lower-GI bleeding. Scintigraphy serves to localize sites of active GI bleeding and stratify those patients who would benefit from aggressive treatment (surgery or arteriography) vs those who can be managed medically. Pretest involvement of respective services is critical for successful bleeding site confirmation and therapy by interventional radiology or surgery or both. Single photon emission computed tomography/computed tomography erythrocyte scintigraphy has demonstrated superior accuracy and precision over planar scintigraphy in the diagnosis of acute GI bleeding. Additionally, single photon emission computed tomography/computed tomography scintigraphy of GI bleeding provides useful supplemental anatomical information that benefits patient management.
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Affiliation(s)
- Thomas W Allen
- Department of Radiology, Division of Nuclear Medicine, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA.
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Usefulness of the Tensile Gallbladder Fundus Sign in the Diagnosis of Early Acute Cholecystitis. AJR Am J Roentgenol 2013; 201:340-6. [DOI: 10.2214/ajr.12.9919] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Soyer P, Hoeffel C, Dohan A, Gayat E, Eveno C, Malgras B, Pautrat K, Boudiaf M. Acute cholecystitis: quantitative and qualitative evaluation with 64-section helical CT. Acta Radiol 2013; 54:477-86. [PMID: 23390157 DOI: 10.1177/0284185113475798] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Because of an expanded role for CT in the evaluation of patients with acute abdominal pain, it is not rare that acute cholecystitis is depicted by CT. However, the sensitivity and the specificity of a given CT variable for the diagnosis of acute cholecystitis is not known. PURPOSE To quantitatively and qualitatively analyze acute cholecystitis at 64-section helical CT with submilimeter and isotropic voxels using a retrospective case-control study. MATERIAL AND METHODS The 64-section helical CT examinations obtained with submilimeter and isotropic voxels in 40 patients with acute cholecystitis (25 men; mean age, 62.2 years) were quantitatively and qualitatively analyzed and compared to those of 40 control subjects matched for age and gender. Receiver-operating characteristic (ROC) curve analysis was used to determine the most discriminating cut-off values for quantitative variables. Comparisons of qualitative variables were made using univariate analysis. RESULTS Pericholecystic fat stranding, mural stratification, pericholecystic hypervascularity, spontaneous hyperattenuation of gallbladder wall, short (≥ 32-mm) and long (≥ 74-mm) gallbladder axis enlargement, and gallbladder wall thickening (≥ 3.6-mm) were the most discriminating and independent variables for the diagnosis of acute cholecystitis (P < 0.0001). Using cut-off values found at ROC curve analysis, gallbladder wall thickening, and short and long gallbladder axis enlargement were the most sensitive findings (sensitivity = 92.5%; 95%CI: 79.6%-98.4%) for the diagnosis of acute cholecystitis. CONCLUSION Acute cholecystitis is associated with myriad suggestive findings on 64-section helical CT. It can be anticipated that familiarity with these findings would result in more confident diagnosis of acute cholecystitis at 64-section helical CT.
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Affiliation(s)
- Philippe Soyer
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris
- Université Paris-Diderot, Sorbonne Paris Cité, Paris
- INSERM, U 965, Paris Cedex 10
| | | | - Anthony Dohan
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris
- INSERM, U 965, Paris Cedex 10
| | - Etienne Gayat
- Université Paris-Diderot, Sorbonne Paris Cité, Paris
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris
| | - Clarisse Eveno
- INSERM, U 965, Paris Cedex 10
- Surgical Oncologic & Digestive Unit, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brice Malgras
- Surgical Oncologic & Digestive Unit, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karine Pautrat
- Surgical Oncologic & Digestive Unit, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mourad Boudiaf
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris
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Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan ACW, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:35-46. [PMID: 23340953 DOI: 10.1007/s00534-012-0568-9] [Citation(s) in RCA: 266] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that acute cholecystitis should be suspected when Murphy's sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of acute cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe acute cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of acute cholecystitis, such as leukocytosis, ALP, old age, diabetes, being male, and delay in admission, no new strong evidence has been detected indicating that a change in the criteria used in TG07 is needed. Therefore, it was judged that the severity assessment criteria of TG07 could be applied in the updated Tokyo Guidelines (TG13) with minor changes. TG13 presents new standards for the diagnosis, severity grading and management of acute cholecystitis. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Masamichi Yokoe
- General Internal Medicine, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan.
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Kim SJ, Lee JM, Kim H, Yoon JH, Han JK, Choi BI. Role of diffusion-weighted magnetic resonance imaging in the diagnosis of gallbladder cancer. J Magn Reson Imaging 2012; 38:127-37. [PMID: 23281048 DOI: 10.1002/jmri.23956] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 10/10/2012] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine the additional diagnostic value of high b-value diffusion-weighted imaging (DWI) compared to conventional biliary magnetic resonance imaging (MRI) for differentiating gallbladder (GB) cancer from benign GB diseases with wall thickening. MATERIALS AND METHODS Thirty-nine patients with GB cancers and 36 patients with cholecystitis having preoperative biliary MRIs were included. All patients underwent unenhanced T1- and T2-weighted imaging (T2WI), Gd-enhanced dynamic MRI, and DWI (b values 0, 100, 500, 1000 s/mm(2) ). Two radiologists independently analyzed two sets of MRI for characterization of GB lesions: a conventional biliary image (CBI) set with T1- and T2WI and a dynamic image; and a DWI set composed of DWI and a CBI set. Diagnostic accuracy and sensitivity were evaluated using the receiver operator characteristic method. The mean apparent diffusion coefficient (ADC) values of the lesions were also calculated. RESULTS The Az values were 0.856 and 0.960 for reviewers 1 and 2, respectively, with the CBI set and increased to 0.952 and 0.983 with the DWI set. The mean ADC value of GB carcinoma was 1.46 ± 0.45 × 10(-3) mm(2) /s and that of cholecysititis was 2.16 ± 0.56 × 10(-3) mm(2) /s (P < 0.0001). CONCLUSION Adding DWI to the standard biliary MRI protocol may improve sensitivity for distinguishing GB cancers from benign GB diseases with wall thickening.
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Affiliation(s)
- Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
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Abstract
Hepatobiliary scintigraphy is a mature imaging technique for evaluation of patients with acute cholecystitis (AC). It is effective in calculous and acalculous forms of AC. The test is used in contemporary medical practice as the arbiter when the findings from screening abdominal ultrasound do not fit a clinical picture. It is also performed in severely ill patients who have AC suspected on other testing, but whose frail condition and high operative risk demand the highest level of certainty. This review, therefore, examines all technique variations of hepatobiliary scintigraphy, offering an approach that may best fit a variety of clinical situations and philosophies on AC.
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Affiliation(s)
- Mark Tulchinsky
- Division of Nuclear Medicine, Department of Radiology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, PA 17033, USA.
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Amber IB, Leighton J, Li SY, Greene GS. The hot rim sign on hepatobiliary scintigraphy (HIDA) with CT correlation. BMJ Case Rep 2012; 2012:bcr.09.2011.4778. [PMID: 22665866 DOI: 10.1136/bcr.09.2011.4778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An older male with multiple medical comorbidities presented to the emergency room after 3 days of worsening right upper quadrant pain. The patient had an elevated white blood cell count and mildly elevated liver functions. Initial ultrasound was equivocal and further imaging with CT scan was obtained. The CT scan was read as suggestive of cholecystitis, however a hepatobiliary scintigraphy (HIDA) scan was ordered for confirmation, as the patient was a poor operative candidate. The HIDA demonstrated no bile duct or small bowel activity on initial images or delays, however a classic 'hot rim' sign was present, confirming acute cholecystitis. The patient ultimately underwent percutaneous cholecystostomy with drainage for treatment where acute cholecystitis was confirmed. Upon retrospective review, the CT demonstrated hyperaemia surrounding the gallbladder fossa, which is the CT scan equivalent of a scintigraphic 'hot rim' sign. This is an uncommon example of a radiologic sign correlation between multiple imaging modalities.
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Affiliation(s)
- Ian Blake Amber
- Radiology Department, The Pennsylvania Hospital, University of Penn Health System, Philadelphia, Pennsylvania, USA
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Koyasu S, Isoda H, Tsuji Y, Yamamoto H, Matsueda K, Watanabe Y, Chiba T, Togashi K. Hepatic arterial perfusion increases in the early stage of severe acute pancreatitis patients: evaluation by perfusion computed tomography. Eur J Radiol 2012; 81:43-46. [PMID: 21123016 DOI: 10.1016/j.ejrad.2010.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/01/2010] [Accepted: 11/03/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE Although hepatic perfusion abnormalities have been reported in patients with acute pancreatitis, hepatic perfusion with severe acute pancreatitis (SAP) has not been quantitatively evaluated in humans. Therefore, we investigated hepatic perfusion in patients with SAP using perfusion CT. MATERIALS AND METHODS Hepatic perfusion CT was performed in 67 patients with SAP within 3 days after symptom onset. The patients were diagnosed as having SAP according to the Atlanta criteria. Fifteen cases were established as a control group. Perfusion CT was obtained for 54s beginning with a bolus injection of 40 ml of contrast agent (600-630 mgI/kg) at a flow rate of 4 ml/s. Perfusion data were analyzed by the dual-input maximum slope method to obtain hepatic arterial perfusion (HAP) and hepatic portal perfusion (HPP). Finally, we compared HAP and HPP in SAP patients with those in the control group, respectively. RESULTS Average HAP was significantly higher in SAP patients than in the control group (75.1 ± 38.0 vs. 38.2 ± 9.0 ml/min/100ml; p<0.001). There was no significant difference in average HPP between SAP patients and the control group (206.7 ± 54.9 vs. 204.4 ± 38.5 ml/min/100ml; p=0.92). CONCLUSION Using quantitative analysis on perfusion CT, we first demonstrated an increase of HAP in the right hepatic lobe in SAP patients.
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Affiliation(s)
- Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Abstract
Recent advances in multidetector-row computed tomography, magnetic resonance imaging, and ultrasonography have led to the detection of incidental hepatic lesions in both the oncology and nononcology patient population that in the past remained undiscovered. These incidental hepatic lesions have created a management dilemma for both clinicians and radiologists. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidentalomas are presented.
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Zhang XM, Mitchell DG, Byun JH, Verma SK, Bergin D, Witkiewicz A. Gallbladder abnormalities in carcinoma of pancreatic head: findings on MR imaging. ACTA ACUST UNITED AC 2009; 34:507-13. [PMID: 18546035 DOI: 10.1007/s00261-008-9422-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Our objective is to study the gallbladder abnormalities on MR images associated with carcinoma of the pancreatic head. METHODS Thirty-six patients who had surgical resection of pancreatic head carcinoma were retrospectively analyzed regarding the appearance of the tumor and gallbladder on MR imaging performed within one month before surgery. The changes of the gallbladder wall, and the dimension of the gallbladder, cystic duct, pericholecystic region, and common bile duct (CBD) on MR imaging were noted. RESULTS About 92% (33/36) of patients had at least one gallbladder abnormality on MR imaging, including thickened gallbladder wall (58%), gallbladder wall striation (19%), gallbladder wall severe enhancement (44%), enlarged gallbladder (33%), gallbladder stone (19%), dilatation of cystic duct (67%), focally increased liver parenchymal enhancement adjacent to the gallbladder (19%), and pericholecystic fluid (11%). 64% of patients had dilated CBD. The diameter of the cystic duct was correlated with those of the CBD (r = 0.45, P < 0.01) and gallbladder (r = 0.56, P < 0.0001). Enlarged gallbladder, dilatation of the cystic duct, and CBD were correlated with chronic cholecystitis. CONCLUSION Most patients with pancreatic head carcinoma show gallbladder abnormalities on MR imaging. Cystic duct dilatation follows CBD dilatation and is the primary cause for dilated gallbladder and chronic cholecystitis in carcinoma of pancreatic head.
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Affiliation(s)
- Xiao Ming Zhang
- Department of Radiology, Thomas Jefferson University Hospital, 1094 Main Bulding, Philadelphia, PA 19107, USA.
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Tsai MJ, Chen JD, Tiu CM, Chou YH, Hu SC, Chang CY. Can acute cholecystitis with gallbladder perforation be detected preoperatively by computed tomography in ED? Correlation with clinical data and computed tomography features. Am J Emerg Med 2009; 27:574-81. [PMID: 19497464 DOI: 10.1016/j.ajem.2008.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 04/23/2008] [Accepted: 04/24/2008] [Indexed: 01/14/2023] Open
Abstract
PURPOSE The purpose of this study is to determine which computed tomography (CT) findings and clinical data can help to diagnose gallbladder perforation in acute cholecystitis. MATERIALS AND METHODS The medical records and CT findings of patients with surgically proven acute cholecystitis within the last recent 5 years were retrospectively reviewed and compared between 2 groups with and without gallbladder perforation. RESULTS A total of 75 patients with acute cholecystitis were included in the study, and 16 patients were proven to have gallbladder perforation. Higher mortality rate was found in the perforation group (18.8% vs 1.7%; P = .029). Older age (>70 years; P = .004) and higher percentage of segmented neutrophil (>80%; P = .027) were significant clinical factors for predicting gallbladder perforation in acute cholecystitis. The significant CT signs related to gallbladder perforation included visualized gallbladder wall defect (P = .000), intramural gas (P = .043), intraluminal gas (P = .000), intraluminal membrane (P = .043), pericholecystic abscess or biloma formation (P = .009), intraperitoneal free air (P = .001), and presence of ascites in the absence of hypoalbuminemia or other intraabdominal malignancy (P = .017). In multivariate analysis, visualized gallbladder wall defect was the most significant predicting CT feature for diagnosing gallbladder perforation in acute cholecystitis. CONCLUSION Elderly patients with higher segmented neutrophil and CT signs of gallbladder wall defect associated with acute cholecystitis may have high possibility of gallbladder rupture.
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Affiliation(s)
- Ming-Jen Tsai
- Department of Emergency Medicine, Buddhist Tzu-Chi General Hospital, Hualien 970, Taiwan
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Kim YK, Kwak HS, Kim CS, Han YM, Jeong TO, Kim IH, Yu HC. CT findings of mild forms or early manifestations of acute cholecystitis. Clin Imaging 2009; 33:274-280. [PMID: 19559349 DOI: 10.1016/j.clinimag.2008.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 11/15/2008] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective of this study was to determine the most predictive CT feature of the mild forms or early manifestations of acute cholecystitis. MATERIALS AND METHODS Two radiologists analyzed CT of 34 patients with mild or early acute cholecystitis and 34 control patients for pericholecystic increased attenuation on the arterial phase, indistinctness of the interface between the gallbladder (GB) and the liver, enhancement of the GB wall, and increased attenuation of the GB bile. RESULTS There were significant differences in the mean values for each CT feature but increased attenuation of the GB bile between patients and control group (P<.05). The most significant predictor of mild or early acute cholecystitis on CT was the presence of pericholecystic increased attenuation on the arterial phase (sensitivity, 82.4%), followed by indistinctness of the interface between the GB and liver (sensitivity, 38.0%), which were identified by both observers with good agreement (kappa=0.735 and kappa=0.687). CONCLUSIONS The pericholecystic increased attenuation on arterial phase CT was the most significant predictor of mild forms or early manifestations of acute cholecystitis.
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Affiliation(s)
- Young Kon Kim
- Department of Diagnostic Radiology, Chonbuk National University Hospital and Medical School, Keum Am Dong, JeonJu, South Korea
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Tutcu S, Serter S, Kaya Y, Kara E, Neşe N, Pekindil G, Coşkun T. Hepatic perfusion changes in an experimental model of acute pancreatitis: evaluation by perfusion CT. Eur J Radiol 2009; 75:203-6. [PMID: 19501998 DOI: 10.1016/j.ejrad.2009.04.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 04/27/2009] [Indexed: 01/12/2023]
Abstract
PURPOSE It is known that acute pancreatitis may cause secondary changes in several organs. Liver is one of these involved organs. In different experimental studies hepatic damages were shown histopathologically in acute pancreatitis but there are a few studies about perfusion disorders that accompany these histopathologic changes. Perfusion CT (pCT) provides the ability to detect regional and global alterations in organ blood flow. The purpose of the study was to describe hepatic perfusion changes in experimental acute pancreatitis model with pCT. MATERIALS AND METHODS Forty Sprague-Dawley rats of both genders with average weights of 250 g were used. Rats were randomized into two groups. Twenty rats were in control group and 20 in acute pancreatitis group. pCT was performed. Perfusion maps were formed by processing the obtained images with perfusion CT software. Blood flow (BF) and blood volume (BV) values were obtained from these maps. All pancreatic and liver tissues were taken off with laparotomy and histopathologic investigation was performed. Student's t test was used for statistical analyses. RESULTS In pCT we found statistically significant increase in blood volume in both lobes of liver and in blood flow in right lobe of the liver (p<0.01). Although blood flow in left lobe of the liver increased, it did not reach statistical significance. CONCLUSION The quantitative analysis of liver parenchyma with pCT showed that acute pancreatitis causes a significant perfusion changes in the hepatic tissue. Systemic mediators seem to be effective as well as local inflammatory changes in perfusion changes.
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Affiliation(s)
- Semra Tutcu
- Department of Surgery, Celal Bayar University, School of Medicine, Manisa, Turkey
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Cross-sectional imaging of acute and chronic gallbladder inflammatory disease. AJR Am J Roentgenol 2009; 192:188-96. [PMID: 19098200 DOI: 10.2214/ajr.07.3803] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this article is to provide a comprehensive review of the clinical and cross-sectional imaging features of a variety of acute and chronic gallbladder inflammatory diseases. CONCLUSION Inflammatory gallbladder diseases are a common source of abdominal pain and cause considerable morbidity and mortality. Although acute uncomplicated cholecystitis and chronic cholecystitis are frequently encountered, numerous other gallbladder inflammatory conditions may also occur that can be readily diagnosed by cross-sectional imaging.
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Analysis of enhancement pattern of flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis. AJR Am J Roentgenol 2008; 191:765-71. [PMID: 18716107 DOI: 10.2214/ajr.07.3331] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of our study was to determine the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to characterize diffuse gallbladder wall thickening as benign or malignant. MATERIALS AND METHODS MDCT scans obtained during the portal venous phase in 78 patients with gallbladder wall thickening caused by various pathologic conditions were retrospectively reviewed by two blinded observers. The CT features of benign and malignant gallbladder wall thickening were compared by means of univariate and multivariate analyses. The study cases were then divided into five patterns according to enhancement pattern. Using these five patterns, two radiologists reviewed the MDCT images and recorded their diagnostic confidence for differentiating benign versus malignant cause on a 5-point scale. The diagnostic performance of CT was evaluated by each observer using a receiver operating characteristic curve analysis. RESULTS The thicknesses of the inner and outer layers ("thick" enhancing inner layer > or = 2.6 mm, "thin" outer layer < or = 3.4 mm), strong enhancement of the inner wall, and irregular contour of the affected wall were significant predictors for a malignant cause of gallbladder wall thickening (p < 0.001). The two-layer pattern with a strongly enhancing thick inner layer and weakly enhancing or nonenhancing outer layer and the one-layer pattern with a heterogeneously enhancing thick layer were patterns that were significantly associated with gallbladder cancer (p < 0.05). When we consider those two enhancing patterns as a sign of malignancy, the diagnostic accuracy of MDCT was 89.1% and 87.6% for the two observers, respectively. CONCLUSION Analyzing the enhancement pattern of a thickened gallbladder wall on MDCT is helpful in differentiating gallbladder cancer from benign inflammatory diseases.
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Bennett GL. Cholelithiasis, Cholecystitis, Choledocholithiasis, and Hyperplastic Cholecystoses. TEXTBOOK OF GASTROINTESTINAL RADIOLOGY 2008:1411-1456. [DOI: 10.1016/b978-1-4160-2332-6.50084-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Altun E, Semelka RC, Elias J, Braga L, Voultsinos V, Patel J, Balci NC, Woosley JT. Acute cholecystitis: MR findings and differentiation from chronic cholecystitis. Radiology 2007; 244:174-83. [PMID: 17581902 DOI: 10.1148/radiol.2441060920] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To retrospectively determine the sensitivity and specificity of magnetic resonance (MR) imaging for differentiation between acute and chronic cholecystitis, with histopathologic analysis as the reference standard. MATERIALS AND METHODS Institutional review board approval with waived informed consent was obtained for this HIPAA-compliant study. Four reviewers blinded to the cholecystitis type but aware that cholecystitis was present retrospectively evaluated MR images for predetermined findings in 32 patients (15 male, 17 female; mean age +/- standard deviation, 55 years +/- 20) with histopathologically proved acute or chronic cholecystitis. The final MR diagnoses and MR findings in both groups were compared with each other and with the histopathologic diagnoses to determine the sensitivity and specificity of MR imaging. Chi(2) tests were used to detect differences in MR findings between the acute and chronic cholecystitis groups. RESULTS MR imaging sensitivity and specificity for detection of acute cholecystitis were 95% (18 of 19 patients) and 69% (nine of 13 patients), respectively. The sensitivities of increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement were 74% (14 of 19 patients) and 62% (10 of 16 patients), respectively. Both findings had 92% (12 of 13 patients) specificity. Sensitivities of increased wall thickness, pericholecystic fluid, and adjacent fat signal intensity changes were 100% (19 of 19 patients), 95% (18 of 19 patients), and 95% (18 of 19 patients), respectively; specificities were 54% (seven of 13 patients), 38% (five of 13 patients), and 54% (seven of 13 patients), respectively. Pericholecystic abscess, intraluminal membranes, and wall irregularity or defect each had 100% (13 of 13 patients) specificity; sensitivities were 11% (two of 19 patients), 26% (five of 19 patients), and 21% (four of 19 patients), respectively. Increased gallbladder wall enhancement (P<.001) and increased transient pericholecystic hepatic enhancement (P=.003) were the most significantly different between acute and chronic cholecystitis. CONCLUSION Increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement had the highest combination of sensitivity and specificity for the diagnosis and differentiation of acute and chronic cholecystitis.
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Affiliation(s)
- Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Campus Box 7510, 2000 Old Clinic Bldg, Chapel Hill, NC 27599-7510, USA
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Joo SH, Kim MJ, Lim JS, Kim JH, Kim KW. CT diagnosis of Fitz-Hugh and Curtis syndrome: value of the arterial phase scan. Korean J Radiol 2007; 8:40-7. [PMID: 17277562 PMCID: PMC2626697 DOI: 10.3348/kjr.2007.8.1.40] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective We wanted to evaluate the role of the arterial phase (AP) together with the portal venous phase (PP) scans in the diagnosis of Fitz-Hugh-Curtis syndrome (FHCS) with using computed tomography (CT). Materials and Methods Twenty-five patients with FHCS and 25 women presenting with non-specifically diagnosed acute abdominal pain and who underwent biphasic CT examinations were evaluated. The AP scan included the upper abdomen, and the PP scan included the whole abdomen. Two radiologists blindly and retrospectively reviewed the PP scans first and then they reviewed the AP plus PP scans. The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az). Weighted kappa (wk) statistics were used to measure the interobserver agreement for the presence of CT signs of the pelvic inflammatory disease (PID) on the PP images and FHCS as the diagnosis based on the increased perihepatic enhancement on both sets of images. Results The individual diagnostic accuracy of FHCS was higher on the biphasic images (Az = 0.905 and 0.942 for reader 1 and 2, respectively) than on the PP images alone (Az = 0.806 and 0.706, respectively). The interobserver agreement for the presence of PID on the PP images was moderate (wk = 0.530). The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719). Conclusion Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.
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Affiliation(s)
- Seung Ho Joo
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul 120-752, Korea.
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Acute Abdominal Pain: Diagnostic Strategies. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Percutaneous Cholecystostomy in the Management of Acute Cholecystitis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2007. [DOI: 10.1097/01.idc.0000240865.27930.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeong YJ, Kim S, Wook YD, Lee JW, Kim KI, Lee SH. Scrub typhus: clinical, pathologic, and imaging findings. Radiographics 2007; 27:161-72. [PMID: 17235005 DOI: 10.1148/rg.271065074] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The main pathologic change is focal or disseminated vasculitis caused by the destruction of endothelial cells and the perivascular infiltration of leukocytes. The diagnosis of scrub typhus is based on the patient's history of exposure, clinical features, and results of serologic testing. Regional and generalized lymphadenopathy is common. The pulmonary manifestations of scrub typhus include interstitial pneumonia, interstitial edema, and hemorrhage caused by vasculitis. Abdominal manifestations include splenomegaly, periportal edema, gallbladder wall thickening, and lymphadenopathy. Although the severity of scrub typhus varies considerably, involvement of the central nervous system is seen in almost all patients and can result in meningoencephalitis. A high degree of clinical suspicion and familiarity with the various radiologic manifestations of scrub typhus allow early diagnosis and timely initiation of appropriate therapy, and thereby may help reduce patient morbidity.
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Affiliation(s)
- Yeon Joo Jeong
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, 1-10 Ami-Dong, Seo-gu, Pusan 602-739, Republic of Korea
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Zins M, Boulay-Coletta I, Molinié V, Mercier-Pageyral B, Jullès MC, Rodallec M, Petit E, Berrod JL. Imagerie des épaississements de la paroi vésiculaire. ACTA ACUST UNITED AC 2006; 87:479-93. [PMID: 16691177 DOI: 10.1016/s0221-0363(06)74028-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Thickening of the gallbladder wall may result from a large spectrum of pathological conditions, intrinsic as well as extrinsic to the biliary tract, and may have different appearances. Accurate diagnosis is usually established after a correlation of imaging findings, laboratory data and clinical history. US remains the initial imaging modality for the evaluation of acute right upper quadrant pain. CT and MRI are complementary to US and have an increasing role in assessing a thickened-wall gallbladder.
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Affiliation(s)
- M Zins
- Service de Radiologie, Fondation Hôpital Saint Joseph, 185, rue Raymond-Losserand, 75014 Paris.
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Tajima T, Yoshimitsu K, Irie H, Aibe H, Shinozaki K, Nishie A, Asayama Y, Nakayama T, Kakihara D, Honda H. Portal vein occlusion or stenosis in patients with hepatolithiasis: observation by multiphasic contrast-enhanced CT. Clin Radiol 2005; 60:469-78. [PMID: 15767105 DOI: 10.1016/j.crad.2004.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Revised: 09/21/2004] [Accepted: 09/22/2004] [Indexed: 11/23/2022]
Abstract
AIMS To analyze the dynamic findings of multiphasic contrast-enhanced CT in hepatolithiasis and to elucidate occlusive changes in portal veins and other associated abnormalities. METHODS This was a retrospective study of 25 selected patients with hepatolithiasis who underwent various imaging examinations, including multiphasic contrast-enhanced CT. The following CT findings were evaluated in each of 71 hepatic segments: visualization of a calculus; biliary dilation or focal hepatic atrophy of the affected segment; areas that were abnormally enhanced in the hepatic arterial phase; degrees (normal, stenosis, occlusion) of portal vein calibre; and linear delayed enhancement along the bile-duct walls, suggesting cholangitis. RESULTS On CT, calculi were depicted as a hyperdense structures in 61 of 71 segments (86%). Focal hepatic atrophy, which frequently accompanied CT findings suggesting compensatory hypertrophy of other segments, was seen in 50 of 71 segments (70%). Areas that were abnormally enhanced were recognized in 36 of 71 segments (51%). Stenosis or occlusion of portal venous branches was observed in 59 of 71 segments (83%), including 13 segments with occlusion. Findings indicating cholangitis were noted in 50 of 71 segments (70%). The degrees of portal vein calibre were significantly correlated with the presence of hepatic atrophy or cholangitis. CONCLUSION Hepatolithiasis is associated with significant rates of stenosis or occlusion of adjacent portal veins as well as hepatic parenchymal changes in the affected area. Chronic deterioration of portal flow may cause these morphological changes.
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Affiliation(s)
- T Tajima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Singh AK, Sagar P. Gangrenous cholecystitis: prediction with CT imaging. ACTA ACUST UNITED AC 2005; 30:218-21. [PMID: 15812680 DOI: 10.1007/s00261-004-0217-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Accepted: 04/07/2004] [Indexed: 12/19/2022]
Abstract
The aim of this study is to determine the usefulness of different patterns of gallbladder mucosal enhancement on contrast-enhanced computed tomography (CT) for differentiating between gangrenous and uncomplicated acute cholecystitis. This retrospective evaluation involved 56 patients with histopathologically proved acute cholecystitis (32 with gangrenous and 24 with uncomplicated acute cholecystitis) who had preoperative contrast-enhanced CT imaging. CT in 38 patients showed a gallbladder mucosal enhancement pattern that could be categorized into continuous, discontinuous, and/or irregular categories. In the other 18 patients, the mucosal enhancement pattern could not be classified due to lack of mucosal enhancement or inadequate mucosal enhancement. On contrast-enhanced CT evaluation, continuous and discontinuous and/or irregular mucosal enhancement patterns were seen in 20 and 18 patients, respectively. Among the 20 patients with continuous mucosal enhancement, 17 had uncomplicated acute cholecystitis. Seventeen of the 18 patients with discontinuous and/or irregular mucosal enhancement had gangrenous cholecystitis. The sensitivity and positive predictive value (PPV) of discontinuous and/or irregular mucosal enhancement in the diagnosis of gangrenous cholecystitis were 30.3% and 94.4% (17 of 18), respectively. The sensitivity and PPV of continuous mucosal enhancement in the diagnosis of uncomplicated acute cholecystitis were 30.3% and 85.5% (17 of 20), respectively. There was a statistically significant difference (p=0.0005) between the PPV of discontinuous and/or irregular (94.4%) and that of continuous (15%) mucosal enhancement for predicting gangrenous cholecystitis. The pattern of gallbladder mucosal enhancement on CT can be used as a reliable criterion for distinguishing acute, uncomplicated cholecystitis from gangrenous cholecystitis.
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Affiliation(s)
- A K Singh
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, White 270, 55 Fruit Street, Boston, MA 02114, USA.
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Grand D, Horton KM, Fishman EK, Fishman E. CT of the gallbladder: spectrum of disease. AJR Am J Roentgenol 2004; 183:163-70. [PMID: 15208132 DOI: 10.2214/ajr.183.1.1830163] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- David Grand
- Department of Radiology, Johns Hopkins Hospital, 601 N Caroline St., JHOC 3253, Baltimore, MD 21287, USA
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