Contrast enhanced CT was performed in seven patients with pancreatic disease (chronic pancreatitis, n = 3; pancreatic head cancer, n = 2; mucin-producing pancreatic tumor, n = 2) who showed dilation of the main pancreatic duct (MPD) Minimum intensity projection (Min-IP) images of the pancreas were obtained using multi-projection volume reconstruction (MPVR) software by selecting an oblique slab that contained the entire MPD. Curved reformation (CR) images were obtained using multiplanar reformation (MPR) software by tracing the MPD on the Min-IP image. Both Min-IP images and CR images clearly showed the dilated main pancreatic duct in all seven patients. In three of the seven, obstruction of the MPD in the pancreatic head and the cause of obstruction (tumor mass, n = 2; caliculus, n = 1) were also clearly seen. Min-IP and CR images seem to be useful for the diagnosis of pancreatic diseases.
Helical computed tomography was performed with intravenous contrast material administration in ten patients with hepatic tumors (metastatic tumor, n = 6; hepatocellular carcinoma, n = 4). Maximum intensity projection (MIP) images of intrahepatic portal venous branches and hepatic veins, and shaded surface display (SSD) images of the hepatic tumors were reconstructed for each patient. The MIP image and SSD image were fitted to overlap on a single display to obtain three-dimensional (3-D) images showing both the hepatic vessels and hepatic tumors. Subsegmental localization of the tumors determined from the 3-D images proved to be correct in all of the six patients who received hepatic resection after examination. 3-D images seem to be useful for preoperative assessment of hepatic tumors.
The objective of our study was to evaluate the exposure doses to patients and radiologists during transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) using a new angiographic unit with a digital flat-panel system.Doses were assessed for 24 procedures: 12 using a new unit with a digital flat-panel system and 12 using a conventional unit. Doses to patients' skin were evaluated with thermoluminescent dosimeters behind the left, middle, and right portions of the liver. The doses to the radiologists were measured by an electronic personal dosimeter placed on the chest outside a lead protector. The maximal skin doses to the patients and the dose equivalents, Hp(0.07), to the radiologists were compared between the two procedure groups with each angiographic unit.For procedures with the new unit, the mean maximal skin dose to the patients was 284 +/- 127 (SD) mGy (range, 130-467 mGy), and Hp(0.07) to the radiologists was 62.8 +/- 17.4 muSv. For procedures with the conventional unit, the maximal skin dose to the patients was 1,068 +/- 439 mGy (range, 510-1,882 mGy), and Hp(0.07) to the radiologists was 68.4 +/- 25.7 muSv. The maximal skin dose to the patients was significantly lower with the new unit than with the conventional unit (p < 0.0005). There was no significant difference in the Hp(0.07) to the radiologists between the two procedure groups.The new digital flat-panel system for angiographic imaging can reduce the radiation dose to patients' skin during TAE for HCC as compared with the conventional system.
A patient with Cowden disease and multiple arteriovenous malformations (AVMs) that resulted in high output heart failure is described. Cowden disease is a familial syndrome characterized by endodermal, mesodermal and ectodermal dysplasia causing benign and malignant tumors of the skin, breast, gastrointestinal tract, and thyroid gland. Our patient had gastrointestinal polyposis, a right renal tumor, a left lung tumor, an adenomatous goiter, and typical dermatologic findings such as facial papules, acral keratosis, gingival papillomatosis and hemangiomas. AVMs were observed in the pelvis, cervical vertebra, liver, and right supraclavicular area. Transcatheter embolization was performed 7 times for the pelvic AVMs, but the effect decreased with repetition and the patient died of heart failure 2 years after the first embolization. The serum levels of tissue plasminogen activator (t-PA), platelet-derived growth factor (PDGF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and transforming growth factor β1 were high, suggesting that these angiogenic molecules may play a role in the pathogenesis of AVMs in Cowden disease. (Jpn Circ J 1999; 63: 326 - 329)
