This article presented readers with typical enhanced CT and MR images of a patient with epithelioid hemangioendothelioma, and briefly described the pathological mechanisms behind the typical imaging signs, in order to enhance the readers’ understanding and awareness of the typical imaging signs of this rare disease, and thus reduce its underdiagnosis rate and misdiagnosis rate.
Primary liver cancer is the sixth most common malignancy and the third leading cause of cancer-related death worldwide, and hepatocellular carcinoma (HCC) constitutes the majority of primary liver cancer cases. The Liver Imaging Reporting and Data System (LI-RADS) was introduced to standardize the lexicon, acquisition, interpretation, reporting, and data collection of imaging results in patients at increased risk for HCC. LI-RADS allows effective categorization of focal liver lesions, and has been applied in the full clinical spectrum of HCC from diagnosis, biological behavior characterization, prognosis prediction, to treatment response assessment. This review aimed to summarize the recent applications of CT/MRI LI-RADS in the diagnosis, biological behavior characterization and prognosis prediction of HCC, discuss current challenges and shed light on potential future directions.
Liver computed tomography (CT) perfusion is a noninvasive imaging technology which can quantitatively investigate liver function, and it is mainly used in the diagnosis of liver tumors and assessment of liver function in the state of chronic liver diseases. The use of liver CT perfusion was limited in the past because of the high radiation dose. Now new technologies are exploited and they make it possible to reduce the radiation burden while maintaining the imaging quality. This article discusses the research progress of low radiation dose CT perfusion in 3 aspects, including X-ray source, reconstruction algorithm, and improvement of CT scanners and optimization of scanning parameters. Although there are not too many studies of low radiation dose CT perfusion on liver now and many problems need to be solved, the clinical application of it will be very prospective.
Objective To discuss the CT imaging differences between hepatic neuroendocrine neoplasms (NENs) and hepatocellular carcinoma (HCC). Methods The clinical and CT data of 42 patients with hepatic NENs (hepatic NENs group) and 49 patients with HCC (HCC group), who were confirmed by pathology in the West China Hospital of Sichuan University from June 2011 to June 2016, were collected and analyzed retrospectively. This study was based on whether the lesions were larger than 3 cm or not, then CT findings of hepatic NENs patients and HCC patients in different stratification were compared. Results When the lesions were less than 3 cm, the location, contour, and enhancement patterns in the portal vein phase of the tumor had significant differences between the hepatic NENs group and the HCC group (P<0.05), multiple liver lesions, the round shape, and prolonged enhancement in the portal vein phase were more often seen in the hepatic NENs group, but there was no significant on diameter of tumor, boundary of lesion, pseudocapsules, scan density, hypervascularity, enhancement degree in arterial phase, enhancement patterns in arterial phase, daughter foci at liver, retraction, neoplastic artery, arteriovenous invaded, portal vein tumor thrombus, diameter of lymph node, and enhancement degree of lymph node between the 2 groups (P>0.05). And when the lesions were greater than or equal to 3 cm, the location, contour, enhancement patterns in the portal vein phase of the tumor, pseudocapsule, neoplastic artery, and arteriovenous invaded had significant differences between the hepatic NENs group and the HCC group (P<0.05), these CT images were often seen in the hepatic NENs group, such as multiple liver lesions, the lobulated shape, the portal venous phase continuous strengthening, no pseudocapsule, no neoplastic artery, and no arteriovenous invaded, but there was no significant difference on the diameter of tumor, boundary of lesion, scan density, hypervascularity, enhancement degree in arterial phase, enhancement patterns in arterial phase, daughter foci at liver, retraction, portal vein tumor thrombus, diameter of lymph node, and enhancement degree of lymph node between the2 groups (P>0.05). Conclusions No matter whether the lesions’ size are larger than 3 cm or not, the location, contour, and enhancement patterns in the portal vein phase could help for differentiating hepatic NENs from HCC. When the lessions are larger than 3 cm, pseudocapsule, neoplastic artery, and arteriovenous invaded may be useful to differentiate.
ObjectiveTo comparatively analyze the image features of tumorous acute pancreatitis (T-AP) and non-tumorous acute pancreatitis (NT-AP). MethodsSixteen cases of histopathologically proven pancreatic tumors inducing acute pancreatitis and 30 cases of non-tumorous acute pancreatitis were collected, and studied their CT and MRI features. ResultsThere were 16 cases (100%) with focal nodules or masses in T-AP group and none in NT-AP group. The average innerdiameter of main pancreatic ducts in T-AP group was (9.6±6.8) mm, in which 14 cases (87.5%) were dilated. And the average innerdiameter of main pancreatic ducts in NT-AP group was (2.9±0.9) mm, in which 7 cases (23.3%) were dilated. The cases of sinistral portal hypertension (SPH), accompanying cholelithiasis and lymphadenosis between the two groups were 10 (62.5%), 3 (18.8%), 14 (87.5%), and 1 (3.4%), 25 (83.3%), 30 (100%), respectively. The occurrence of manifestation of focal nodules or masses, dilated main pancreatic ducts, SPH, and accompanying cholelithiasis were significantly different (P=0.000) between T-AP and NT-AP groups. While, the differences in enhancement pattern and the occurrence of lymphadenosis between the two groups were not significant (P > 0.05). ConclusionThe image features of T-AP are various. The application of CT and MRI could provide effective diagnostic guidelines for patients with T-AP.
Hepatic angiomyolipoma (HAML) is a rare benign mesenchymal tumor of the liver, which has highly variable imaging appearances, often leads to missed diagnosis and misdiagnosis. The images of 2 patients with HAML confirmed by pathology were presented in this study, and the typical imaging features of the HAML, the underlying pathophysiological mechanism, and the differential diagnosis were briefly summarized so as to deepen the understanding of HAML and to improve the diagnosis and differential diagnosis abilities of HAML, then reduce the rates of missed diagnosis and misdiagnosis of the HAML.
【Abstract】Objective To investigate the CT manifestations of chronic virus hepatitis B. Methods According to the inclusion and exclusion criteria, the clinical data and laboratory information of 120 patients with chronic virus hepatitis B were reviewed retrospectively. All patients underwent standardized contrast-enhanced spiral CT dual-phase scanning of the upper abdomen. The changes of the liver, bile duct, spleen, portal venous system, lymph node of the upper abdomen, peritoneal cavity and pleural cavity were observed and noted. Results CT manifestations of chronic virus hepatitis B were as follows: ①changes of the configuration and shape of the liver, ② changes of the density of the liver, ③intrahepatic perivascular lucency, ④thickening of gallbladder wall and edema of the gallbladder fossa, ⑤splenomegaly, ⑥enlargement of abdominal lymph nodes, ⑦ascites, ⑧abnormalities related to portal hypertension (collateral circulation), and ⑨secondary thoracic changes (pleural and pericardial effusion). Conclusion Chronic virus hepatitis B can demonstrate several abnormal findings involving the liver, gallbladder, lymph nodes, spleen, etc on contrast-enhanced CT scanning.
Objective To discuss the diagnostic value of multidetector CT(MDCT) on encapsulated fat necrosis after operation of abdominal cancer, and to investigate the key differences of CT features between encapsulated fat necrosis and postoperative recurrence or metastasis. Methods CT data of 36 patients with encapsulated fat necrosis after operation of abdominal cancer, who received CT in our hospital between Feb. 2012 to May. 2014 during followed-up were retrospectively analyzed, for the purpose of summarizing the CT characteristics. In addition, the clinical presentation, level of carcinoembryonic antigen (CEA) and CA-125 before and after operation were also taken into account, to explore the difference between encapsulated fat necrosis with tumor recurrence and metastasis. Results Among the 36 patients who had suffered from encapsulated fat necrosis after operation of abdominal cancer, 3 patients (8.3%) had 2 lesions and the rest of 33 patients (91.7%) had solitary lesion(a total of 39 lesions). All lesions showed non homogeneous masses consistent with the surgery path and surrounded by fat density ring and soft tissue density capsule. The size of most lesions (94.8%, 37/39) decreased over time. All lesions were found slightly enhancement in portal phase. Five patients with postoperative tumor metastasis, 31 patients had no recurrence or metastasis. Among the 5 patients who had postoperative tumor metastasis at the same time, postoperative CEA was positive in 3 patients, and postoperative CA-125 was positive in 2 patient. Among the other 31 patients who had no recurrence or metastasis, the levels of postoperative CEA and CA-125 of 1 patient were unknown, and the postoperative CEA and CA-125 of 27 patients in the rest patients(90.0%, 27/30) were both negative. Most of them had no special clinical symptoms, only a few (1 patient)patient had mild abdominal pain without other associated symptoms. Conclusion CT is a valuable tool to reveal and diagnose encapsulated fat necrosis in postoperative abdominal cancer. Combined CT findings(such as location, shape, and density) with CEA, CA-125, and clinical presentation, that is easy to differ it from postoperative recurrence and metastasis.
ObjectiveTo investigate the CT presenting rate and features of gastric bare area (GBA, including the area posterior to GBA and the adipose tissue in the gastrophrenic ligament) without pathologic changes.MethodsThirty cases with superior peritoneal ascites, but without pathological involvement of GBA were included into the study to show the normal condition of GBA, including the presenting rate and CT features. We selected some cases with GBA invasion by inflammation or neoplasm to observe their CT features. ResultsAll cases with superior peritoneal ascites showed the GBA against the contrast of ascites with the presenting rate of 100%. The GBA appeared at the level of gastricesophageal conjunction and completely disappeared at the level of hepatoduodenal ligament and Winslow’s foramen. The maximum scope of GBA presented at the level of the sagital part of the left portal vein with mean right to left distance of （4.39±0.08）cm (3.8~5.7 cm) (distance between the left and right layer of the gastrophrenic ligament). In acute pancreatitis, the width of GBA increased, in which local hypodensity area could be seen. In gastric leiomyosarcoma invading GBA, the mass could not separate from the crus of the diaphragm. In lymphoma and metastasis invading GBA, the thickness of GBA increased and the density was heterogeneous, in which lymph nodes presenting as small nodes or fused mass. ConclusionThe results of this study show that it is helpful to use contrast enhanced spiral CT scanning to observe the change of GBA and to diagnose retroperitoneal abnormalities that involving GBA comprehensively and accurately.
Objective To investigate the spiral CT manifestations of the collateral circulation pathways resulting from splenic vein occlusion (SVO) duo to pancreatic diseases. Methods The CT imaging and clinical data of 33 cases of pancreatic disease with SVO, including 28 cases of pancreatic carcinoma, 3 cases of acute pancreatitis and 2 cases of chronic pancreatitis, were retrospectively analyzed.Results Tortuous and dilated vessels were observed in the areas between splenic hilum and gastric fundus and/or along the gastric greater curvature in all 33 cases. In isolated SVO cases, the short gastric vein (SGV, 86%)，coronary vein (CV, 79%)，gastroepiploic vein (GEV, 79%) and gastrocolic trunk (GCT, 57%) were varicose and dilated. While in nonisolated SVO，other collateral veins such as the right superior colic vein (RSCV, 37%），middle colic vein (MCV, 37%） and posterior superior pancreaticoduodenal vein (PSPDV, 21%） were seen as well. Conclusion The two predominant collateral pathways of SVO are ①SGV→gastric fundal veins→CV， and ②GEV→GCT→SMV. They have characteristic imaging features on spiral CT and are of clinical significance in both preoperative staging of pancreatic carcinoma and the evaluation of pancreatogenic segmental portal hypertension.