The purpose of this study was to evaluate the radiographic and imaging findings of seven patients with polyarteritis nodosa involving the abdomen.Vasculitis should be considered when multiple abdominal organs have abnormal radiologic findings; however, angiography is necessary to specifically diagnose polyarteritis nodosa.
Purpose : To evaluate the triple-phase helical CT findings of adenomatous hyperplasia of the liver.Materials and Methods : Forty-seven cases of adenomatous hyperplasias (size range: 8-45 mm, mean: 14mm) in nineteen patients were confirmed by histologic examination following surgery (n=32) or gun biopsy (n=15) and formed the basis of this study. All patients underwent helical CT scanning involving the injection of100mL nonionic contrast material at a rate of 3mL/sec. Hepatic arterial, portal venous, and equilibrium phase CT images were obtained 30, 60, and 180 seconds, respectively, after the start of contrast injection. The attenuation of each nodule (hyper-, iso-, hypo-, or mixed) was retrospectively determined and the detection rate according to lesion size (≤14mm or >14mm) was evaluated.Results : Nodule attenuation during the hepatic arterial phase was iso- in 31 nodules, hypo-in nine, hyper-in five, and mixed in two. The results obtained for the portal venous phase were iso-attenuation in 34 nodules, hypo-attenuation in ten, hyper-attenuation in one, and mixed in two. During the equilibrium phase, attenuation was iso-in 34 nodules and hypo-in 13. Triple-phase helical CT detected 18 nodules (38 %); the detection rate was 8 % (2/26) in the small size group(≤ 14mm) and 76 % (16/21) in the large size group(> 14mm). This rate was thus significantly higher in the large size group than in that in which lesions were small.Conclusion : Triple -phase helical CT revealed that in cases of adenomatous hyperplasia, attenuation was variable, with iso-attenuation the most frequent type. Seventy-six percent of nodules larger than 14 mm were detected. Adenomatous hyperplasia may be seen during the hepatic arterial phase as a hyper-attenuated nodule.
The purpose of our study was to evaluate the factors related to intraprocedural and postprocedural pain during radiofrequency ablation of hepatocellular carcinomas (HCCs).For this retrospective study, we included 145 patients with 160 HCCs who underwent percutaneous radiofrequency ablation under local and IV conscious sedation from January 2006 to December 2006. Patients' pain was scored using the visual analog scale (VAS) immediately after the procedure. Medical records with CT images were reviewed for patient factors, tumor characteristics, and procedural factors. We determined factors correlated with the higher level of intraprocedural pain and the difference in intraprocedural VAS between a group requiring additional analgesics while hospitalized and a group not requiring more analgesics. Statistical analysis was performed using the two-sample Wilcoxon's rank sum test, the Kruskal-Wallis test, and partial Spearman's correlation analysis.On univariate analysis, patients with large tumors, previously untreated tumors, tumors adjacent to the parietal peritoneum, and those who had undergone multiple ablations and longer duration of ablation reported a higher VAS during the procedure. A significant correlation was seen between the distance of a tumor from the parietal peritoneum and the VAS. On multivariate analysis, tumor location adjacent to the parietal peritoneum was an independent predictor for a higher level of self-reported pain. A group requiring additional analgesics while hospitalized reported a higher VAS than patients not requiring more analgesics.The location of a tumor adjacent to the parietal peritoneum is an independent predictor of higher pain level during percutaneous radiofrequency ablation of HCCs. Modification of intraprocedural anesthesia should be considered in patients with risk factors for increased pain.
OBJECTIVE. Our objective was to assess the feasibility, safety, and efficacy of percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma (HCC) in the hepatic dome.
We reviewed all studies assessing the health-related quality of life (HRQoL) in patients with hepatocellular carcinoma (HCC) between 2009 and 2018 (n = 45).Most studies assessed HRQoL as an outcome, and evaluated or compared the HRQoL of HCC patients depending on the type of treatment or stage of disease.HCC patients had a worse HRQoL than the general population, including in those with early-stage HCC.Patients commonly experienced pain, fatigue, sleep disturbance, distress, and lack of appetite, and these symptoms remained problematic even a few years after treatment.TNM classification of malignant tumors stage, tumor stage, presence of cirrhosis, being Asian, being female, living alone, or being unemployed were associated with a poor HRQoL.While recent studies have included a more diverse patient population, various topics, and different study designs, there were limited studies on supportive interventions.Given the increase in HCC cases and HCC survivors, addressing the HRQoL of HCC patients requires more attention.
Purpose The purpose of this study was to compare the preoperative detectability of hepatocellular carcinomas (HCCs) using combined T2-weighted and dynamic gadolinium-enhanced MRI and combined CT during arterial portography (CTAP) and CT hepatic arteriography (CTHA). Method Thirty-three patients with 43 HCCs underwent T2-weighted and dynamic gadolinium-enhanced MRI and combined CTAP and CTHA. The diagnosis was established by pathologic examination following surgical resection in 26 patients and by biopsy in 7 patients. The MR protocol included fast SE with two TEs (including T2-weighted imaging) and precontrast and gadolinium-enhanced T1-weighted fast multiplanar spoiled gradient-recalled echo images with dynamic study. The MR images of all sequences and the paired CTAP and CTHA images were independently reviewed by three radiologists. Image review was conducted on a segment-by-segment basis. Diagnostic accuracy was evaluated with receiver operating characteristic analysis. Results The accuracies (Az values) of MRI of all sequences and combined CTAP and CTHA for all observers were 0.960 and 0.959, respectively. The mean sensitivities of MRI and CT were 90 and 94%, respectively. The differences were not statistically significant. The mean specificity of MRI (99%) was significantly higher than that of combined CTAP and CTHA (92%). Conclusion Combined T2-weighted and dynamic gadolinium-enhanced MRI is as accurate as combined CTAP and CTHA for preoperative detection of HCCs.
Purpose. To assess usefulness of adding contrast-enhanced ultrasonography (CEUS) to fusion imaging (FI) for percutaneous radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs) inconspicuous on FI alone. Therapeutic outcomes of RFA under CEUS-added FI guidance for HCCs inconspicuous on FI alone were also evaluated. Methods. This prospective study was approved by the institutional review board and informed consent was obtained from all patients. Planning US was performed with FI for 126 patients with a single HCC (1–2 cm) to evaluate the feasibility of RFA by grading lesion conspicuity score using a four-point scale. RFA was performed under CEUS-added FI guidance for HCCs inconspicuous on FI alone. We evaluated how many HCCs initially inconspicuous on FI became conspicuous after adding CEUS. After CEUS-added FI-guided RFA, therapeutic outcomes including rates of technical success, primary technique efficacy, major complications, and local tumor progression were assessed. Results. After adding CEUS, 90.5% (19/21) of all tumors initially inconspicuous on FI became conspicuous, thus enabling direct targeting for RFA. Technical success and primary technique efficacy rates were 94.7% (18/19) and 100% (19/19), respectively. No major complications were observed after RFA. Cumulative local tumor progression rates after RFA were estimated to be 5.3%, 10.8%, and 10.8% at 1, 2, and 3 years, respectively. Conclusion. Adding CEUS to FI is useful for improving the conspicuity of HCCs inconspicuous on FI alone, thus enabling successful percutaneous RFA with excellent therapeutic outcomes.
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