Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Imaging for Diagnosis, Tumor Response to Treatment and Liver Response to Radiation.
Seminars in radiation oncology
2018; 28 (4): 267–76
Contrast media for fluoroscopic examinations of the GI and GU tracts: current challenges and recommendations
2017; 42 (1): 90-100
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) comprise the majority of primary liver cancers. Both HCC and ICC have characteristic imaging appearances on multiphase computed tomography (CT) and magnetic resonance imaging (MRI). Several locoregional therapies, including radiation therapy, are used to treat unresectable disease and residual or recurrent tumor. The tumor response following locoregional therapies has variable imaging manifestations. Focal liver reaction, the imaging changes of the liver following radiation treatment, should be recognized and not mistaken for tumor. We review the diagnostic imaging of HCC and ICC, imaging of tumor response to treatment, and imaging of the liver response to radiation.
View details for DOI 10.1016/j.semradonc.2018.06.010
View details for PubMedID 30309637
Aortoenteric fistulas: spectrum of CT findings
2013; 38 (2): 367-375
One of the significant challenges facing radiologists who perform and interpret studies of the gastrointestinal and genitourinary systems have been periodic interruptions in the availability of barium and iodinated contrast media specially formulated for gastrointestinal (GI) and genitourinary (GU) studies. These interruptions are due to the US Food and Drug Administration's recent requirement for more stringent documentation of the safety and efficacy of contrast media and the consolidation among contrast manufacturers. Therefore, radiologists may be required to recommend an alternative means of evaluation, such as computed tomography, magnetic resonance, or endoscopy, or they may need to substitute a different formulation of a contrast agent not specifically developed for GI or GU use, for example the utilization of an agent designed and marketed for vascular use. This article reviews the current status of fluoroscopic contrast media, and provides suggestions and recommendations for the optimal and alternative use of contrast media formulations.
View details for DOI 10.1007/s00261-016-0861-1
View details for Web of Science ID 000392291700009
View details for PubMedID 27503380
Imaging Manifestations of Abdominal Fat Necrosis and Its Mimics
2011; 31 (7): 2021-2034
This article reviews the causes of aortoenteric fistulas, diagnostic options, and important CT findings.Aortoenteric fistula, a rare but potentially fatal entity, presents a significant challenge to radiologists in diagnosis, largely because of its subtle and nonspecific imaging findings. These fistulas can be divided into primary and secondary forms, depending on the presence or absence of prior aortic reconstructive surgery, but the secondary form is more common. Typical CT findings, which can overlap with those seen in perigraft infection, aortitis, infected/mycotic aneurysms, perianeurysmal fibrosis, and the immediate post-operative period after placement of a graft, include: Effacement of the fat planes around the aorta, perigraft fluid/soft tissue thickening, ectopic gas, tethering of adjacent thickened bowel loops towards the aortic graft, and in rare cases, extravasation of contrast from the aorta into the involved segment of bowel.
View details for DOI 10.1007/s00261-012-9873-7
View details for Web of Science ID 000316144100019
View details for PubMedID 22366854
Septic Thrombophlebitis of the Portal Venous System: Clinical and Imaging Findings in Thirty-Three Patients
DIGESTIVE DISEASES AND SCIENCES
2011; 56 (7): 2179-2184
Intraabdominal fat is a metabolically active tissue that may undergo necrosis through a number of mechanisms. Fat necrosis is a common finding at abdominal cross-sectional imaging, and it may cause abdominal pain, mimic findings of acute abdomen, or be asymptomatic and accompany other pathophysiologic processes. Common processes that are present in fat necrosis include torsion of an epiploic appendage, infarction of the greater omentum, and fat necrosis related to trauma or pancreatitis. In addition, other pathologic processes that involve fat may be visualized at computed tomography, including focal lipohypertrophy, pathologic fat paucity (lipodystrophies), and malignancies such as liposarcoma, which may mimic benign causes of fat stranding. Because fat necrosis and malignant processes such as liposarcoma and peritoneal carcinomatosis may mimic one another, knowledge of a patient's clinical history and prior imaging studies is essential for accurate diagnosis.
View details for DOI 10.1148/rg.317115046
View details for Web of Science ID 000297047000019
View details for PubMedID 22084185
Chemoembolization for Unresectable HepatoCellular Carcinoma in Patients with or without Portal Vein Thrombosis
2010; 58 (104): 1375-1381
Managing Incidental Findings on Abdominal CT: White Paper of the ACR Incidental Findings Committee
JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY
2010; 7 (10): 754-773
Xanthogranulomatous cholecystitis: Diagnostic performance of CT to differentiate from gallbladder cancer
EUROPEAN JOURNAL OF RADIOLOGY
2010; 74 (3): E80-E84
Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver
2009; 64 (12): 1190-1195
Our purpose was to review the clinical and imaging findings in a series of patients with septic thrombophlebitis of the portal venous system in order to define criteria that might allow more confident and timely diagnosis.This is a retrospective case series. The clinical and imaging features were analyzed in 33 subjects with septic thrombophlebitis of the portal venous system.All 33 patients with septic thrombophlebitis of the portal venous system had pre-disposing infectious or inflammatory processes. Contrast-enhanced CT studies of patients with septic thrombophlebitis typically demonstrate an infectious gastrointestinal source (82%), thrombosis (70%), and/or gas (21%) of the portal system or its branches, and intrahepatic abnormalities such as a transient hepatic attenuation difference (THAD) (42%) or abscess (61%).Septic thrombophlebitis of the portal system is often associated with an infectious source in the gastrointestinal tract and sepsis. Contrast-enhanced CT demonstrates an infectious gastrointestinal source, thrombosis or gas within the portal system or its branches, and intrahepatic abnormalities such as abscess in most cases. We report a THAD in several of our patients, an observation that was not made in prior reports of septic thrombophlebitis.
View details for DOI 10.1007/s10620-010-1533-6
View details for Web of Science ID 000291481800038
View details for PubMedID 21221797
Liver Lesions With Hepatic Capsular Retraction
SEMINARS IN ULTRASOUND CT AND MRI
2009; 30 (5): 426-435
Nodular regenerative hyperplasia (NRH) and large regenerative nodules (LRN) are distinct types of hepatocellular nodules that have been confused in the radiology literature. However, distinction is critical because their clinical significance is quite different. Our purpose was to review the clinical and imaging findings in a series of patients with NRH and LRN in order to identify distinguishing clinical and imaging features.This was a retrospective case series. The clinical and imaging features were compared in 36 patients with pathological proof of NRH and 23 patients with pathological evidence of LRN.NRH and LRN have different predisposing factors and imaging findings. NRH is often associated with organ transplantation, myeloproliferative disease, or autoimmune processes. Livers with NRH typically do not have enhancing nodules; none of the present patients with NRH had enhancing liver masses. In contrast, LRN are often associated with Budd-Chiari syndrome. Enhancing liver masses were noted in 19 (83%) of the 23 patients with LRN. The p values for the comparisons were less than 0.001 for both enhancing liver masses and hepatic vein thrombosis.NRH and LRN can have distinct clinical presentations and imaging appearances. LRN often result in enhancing liver nodules, whereas NRH usually does not. Clinical and imaging information enables the distinction of LRN and NRH in many cases.
View details for DOI 10.1016/j.crad.2009.07.015
View details for Web of Science ID 000273305900007
View details for PubMedID 19913129
Spontaneous Abdominal Hemorrhage: Causes, CT Findings, and Clinical Implications
AMERICAN JOURNAL OF ROENTGENOLOGY
2009; 193 (4): 1077-1087
Retraction of the liver capsule may be associated with a diverse spectrum of benign and malignant etiologies. The more common causes include focal confluent fibrosis in cirrhotic livers, cholangiocarcinoma, and treated liver tumors, such as hepatocellular carcinoma, metastases, and lymphoma. Less common etiologies include primary sclerosing cholangitis, epithelioid hemangioendothelioma, hepatic hemangioma, solitary fibrous tumor of the liver, and hepatic inflammatory pseudotumor. Hepatic capsular retraction may also result from iatrogenic and noniatrogenic trauma. Due to the diversity and different nature of the various etiologies associated with this sign, it is important that radiologists be familiar with the characteristic features of these abnormalities, to avoid misdiagnosis that may adversely affect the therapeutic approach. It is also important to know that, contrary to some reports, hepatic capsular retraction is not a sign of malignant disease. The purpose of this article is to familiarize readers with the spectrum of benign and malignant etiologies of this sign and to point out additional computed tomographic findings that may allow confident diagnosis of the specific hepatic lesion responsible for the capsular retraction. The hepatic capsular and subcapsular regions may be affected by focal or diffuse pathologies affecting the liver. This hepatic area is more prone to be involved in various malignant and benign diseases due to several factors: the negative subdiaphragmatic pressure that may draw infected material and malignant cells toward the diaphragm, the perihepatic ligaments connecting the liver capsule with adjacent viscera, forming a direct root of dissemination, and the systemic blood inflow that supplies this region in addition to the portal and hepatic arterial blood flow. This is the reason for the multiple pathologic conditions and pseudolesions that occur at the hepatic capsular and subcapsular regions.
View details for DOI 10.1053/j.sult.2009.06.002
View details for Web of Science ID 000270442900006
View details for PubMedID 19842567
Imaging Approach for Evaluation of Focal Liver Lesions
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
2009; 7 (6): 624-634
The purpose of this article is to present the most common causes of spontaneous abdominal hemorrhage and to review the CT findings that are important in establishing the correct diagnosis and in guiding appropriate therapy.Knowledge of the common CT manifestations of various causes of spontaneous abdominal hemorrhage allows their accurate diagnosis and has a direct impact on clinical decision making.
View details for DOI 10.2214/AJR.08.2231
View details for Web of Science ID 000270033300023
View details for PubMedID 19770332
CT Hypotension Complex (Shock Bowel) Is Not Always Due to Traumatic Hypovolemic Shock
AMERICAN JOURNAL OF ROENTGENOLOGY
2009; 192 (5): W230-W235
Focal liver lesions are common in the general population. Radiology (imaging) plays a pivotal role for the diagnosis, staging, treatment planning, and follow-up of focal liver lesions. To maximize lesion detection and characterization, imaging needs to be performed with appropriate equipment by using protocols carefully designed on the basis of the underlying clinical context. In addition, the decision of an imaging modality cannot be based on the diagnostic accuracy of an imaging test solely but must also consider patient safety and cost-effectiveness.
View details for DOI 10.1016/j.cgh.2009.03.024
View details for Web of Science ID 000267189400006
View details for PubMedID 19348962
Focal Confluent Fibrosis in Cirrhotic Liver: Natural History Studied with Serial CT
AMERICAN JOURNAL OF ROENTGENOLOGY
2009; 192 (5): 1341-1347
The purpose of our study was to review the clinical and CT findings in a substantial series of 41 patients with the shock bowel sign to determine if there is an association between shock bowel (and other CT signs of hypotension) and conditions other than post-traumatic hypovolemic shock.The shock bowel sign and the CT hypotension complex are frequently associated with hypotension from causes other than trauma-induced hypovolemic shock, such as severe head or spine injury, cardiac arrest, septic shock, bacterial endocarditis, and diabetic ketoacidosis. Other elements of the CT hypotension complex such as flattening of the inferior vena cava and aorta, abnormal pancreatic enhancement and peripancreatic fluid, and hypoperfusion of the spleen and liver are variably associated with shock bowel whether due to posttraumatic hypovolemia or other causes of hypotension. The CT hypotension complex (shock bowel) has important prognostic and therapeutic implications and can probably be distinguished from bowel trauma and other forms of bowel injury in most cases.
View details for DOI 10.2214/AJR.08.1474
View details for Web of Science ID 000265387300049
View details for PubMedID 19380528
Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: Incidence and organ distribution
AMERICAN JOURNAL OF ROENTGENOLOGY
2002; 178 (1): 17-20
The objective of this study was to assess the long-term natural history of focal confluent fibrosis in cirrhotic liver with CT.Two radiologists retrospectively reviewed in consensus 118 liver CT examinations in 26 patients (19 men, seven women; age range, 32-68 years; mean age, 50 years) performed over approximately 6 years. Helical CT scans were obtained before and 30-35 and 65-70 seconds after injection of 125-150 mL of contrast medium at a rate of 4-5 mL/s. Proof of cirrhosis was based on liver transplantation (n = 6), biopsy (n = 9), or imaging findings (n = 11). The number, location, and attenuation of fibrotic lesions and presence of trapped vessels were evaluated. Variation of hepatic retraction associated with the development of focal confluent fibrosis lesions was assessed using the ellipsoid volume formula and an arbitrary retraction index.Each radiologist identified 41 focal confluent fibrosis lesions. All lesions were identified by both radiologists. Twelve patients (46%) had a single lesion, 13 (50%) had two lesions, and one (4%) had three lesions. Thirty-four (83%) of 41 lesions were located in segment IV, VII, or VIII. Thirty-two lesions (78%) were hypoattenuating on unenhanced images, 25 lesions (61%) were hypoattenuating on hepatic arterial phase images, and 20 lesions (49%) were isoattenuating on portal venous phase images. Seven lesions (17%) were or became hyperattenuating at follow-up on portal venous phase images. Trapped vessels were found in six lesions (15%). The retraction index showed a significant increase over time (r = 0.423, p < or = 0.0001).The degree of capsule retraction associated with focal confluent fibrosis evolves with time and relates to the natural evolution of cirrhosis.
View details for DOI 10.2214/AJR.07.2782
View details for Web of Science ID 000265387300028
View details for PubMedID 19380559
We evaluated the incidence and organ distribution of arterial extravasation identified using contrast-enhanced helical CT in patients who had sustained abdominal visceral injuries and pelvic fractures after blunt trauma.Five hundred sixty-five consecutive patients from four level I trauma centers who had CT scans showing abdominal visceral injuries or pelvic fractures were included in this series. The presence or absence of arterial extravasation, as well as the anatomic sites of arterial extravasation, was noted. We obtained clinical follow-up data, including surgical or angiographic findings.In our series, 104 (18.4%) of 565 patients had arterial extravasation. Of the 104 patients, 81 (77.9%) underwent surgery, embolization, or both. The combined rate of surgery or embolization in patients with arterial extravasation was statistically higher than expected at all four institutions (p <0.001). The spleen was the most common organ injured, occurring in 277 (49.0%) of 565 patients, and arterial extravasation occurred in 49 (17.7%) of 277 patients with splenic injury. Several other visceral injuries were associated with arterial extravasation, including hepatic, renal, adrenal, and mesenteric injuries.Based on the limited reports of arterial extravasation in the nonhelical CT literature, the percentage (18%) of clinically stable patients in our study with CT scans showing arterial extravasation was higher than anticipated. This finding likely reflects the improved diagnostic capability of helical CT. Although the spleen and liver were the organs most commonly associated with arterial extravasation, radiologists should be aware that arterial extravasation may be associated with several other visceral injuries.
View details for Web of Science ID 000172927900003
View details for PubMedID 11756079