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Bruna-Mejias A, Salgado-Torres C, Cáceres-Gálvez C, Rodriguez-Osorio B, Orellana-Donoso M, Nova-Baeza P, Suazo-Santibañez A, Oyanedel-Amaro G, Sanchis-Gimeno J, Piagkou M, Triantafyllou G, Konschake M, Valenzuela-Fuenzalida JJ. The Gastric Vein Variants: An Evidence-Based Systematic Review of Prevalence and Clinical Considerations. J Clin Med 2025; 14:3630. [PMID: 40507393 PMCID: PMC12155747 DOI: 10.3390/jcm14113630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2025] [Revised: 05/18/2025] [Accepted: 05/20/2025] [Indexed: 06/16/2025] Open
Abstract
Background: The objective of the present systematic study was to analyze and characterize the gastric vein (GV) variations to understand their significance within clinical contexts, particularly in gastric and liver surgeries and managing conditions associated with the portal vein system. Methods: We conducted a systematic review, examining various databases, including Medline, Scopus, Web of Science, Google Scholar, CINAHL, and EMBASE, up to April 2025. Two independent authors conducted the literature search, selected pertinent studies, and extracted relevant data. The methodological quality of the studies was evaluated utilizing the Assessment Tool for Anatomical Studies (AQUA). The pooled prevalence was estimated through the application of a random effects model. Results: Among the 279 articles reviewed, 11 studies were ultimately incorporated into the systematic analysis, encompassing 47,993 subjects. The pooled prevalence of GV variants was determined to be 8.32%, revealing considerable heterogeneity (I2 = 98.92%). A subgroup analysis showed a greater prevalence of GV variants in diagnostic imaging studies than in cadaveric studies, with a higher frequency observed in males than in females. Conclusions: The morphological variability of the GVs holds clinical significance, as it may significantly impact the management of abdominal disorders, particularly during surgical and endovascular interventions. This study emphasizes the necessity of thorough preoperative evaluations to identify these variations, thereby minimizing surgical complications and enhancing therapeutic outcomes for patients suffering from gastric and portal vein system disorders. Integrating advanced imaging techniques into clinical practice may facilitate improved surgical and therapeutic planning.
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Affiliation(s)
- Alejandro Bruna-Mejias
- Departamento de Ciencias y Geografía, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaíso 2360072, Chile;
| | - Cristian Salgado-Torres
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (C.S.-T.); (C.C.-G.); (B.R.-O.); (P.N.-B.)
| | - Constanza Cáceres-Gálvez
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (C.S.-T.); (C.C.-G.); (B.R.-O.); (P.N.-B.)
| | - Benjamin Rodriguez-Osorio
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (C.S.-T.); (C.C.-G.); (B.R.-O.); (P.N.-B.)
| | - Mathias Orellana-Donoso
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile;
- Faculty of Medicine and Science, Universidad San Sebastián, Santiago 8420524, Chile
| | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (C.S.-T.); (C.C.-G.); (B.R.-O.); (P.N.-B.)
| | | | - Gustavo Oyanedel-Amaro
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 8910060, Chile;
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain;
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.P.); (G.T.)
- Neurosurgical Research Center, Petros Kokalis, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Triantafyllou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.P.); (G.T.)
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck (MUI), Müllerstrasse 59, 6020 Innsbruck, Austria;
| | - Juan Jose Valenzuela-Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (C.S.-T.); (C.C.-G.); (B.R.-O.); (P.N.-B.)
- Neurosurgical Research Center, Petros Kokalis, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Borhani AA, Patel N, Patel V, Haghshomar M, Grimaldi G, Miller FH, McGinty K. Benign pericholecystic regeneration mimicking hepatocellular carcinoma: a potential pitfall in imaging of cirrhosis. Abdom Radiol (NY) 2025; 50:1547-1554. [PMID: 39347976 DOI: 10.1007/s00261-024-04618-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/17/2024] [Accepted: 09/24/2024] [Indexed: 10/01/2024]
Abstract
Several pseudolesions mimicking malignancy have been reported in cirrhotic and non-cirrhotic livers. Pericholecystic regeneration is among those pseudolesions and can occasionally mimic malignancy. Herein we present a case series comprised of 10 cirrhotic patients (majority due to alcoholic liver disease [ALD] or metabolic dysfunction associated steatotic liver disease [MASLD]) with pericholecystic observations initially categorized as highly suspicious for HCC (LR-4 and LR-5) due to their suspicious enhancement pattern which were later proven to be benign based on biopsy, transplantation or imaging criteria (stability of size and morphology on serial CT or MRI for > 2 years). These observations ranged 2-6.3 cm in size, were multiple in most patients and universally resulted in indentations of gallbladder. Arterial phase hyperenhancement and washout, features usually attributed to hepatocellular carcinoma (HCC), were seen in most patients. However, ancillary features of malignancy such as diffusion restriction, increased T2 signal, and hypointensity on hepatobiliary phase MRI were not present. Pericholecystic observations, in particular in the setting of ALD and MASLD, should be carefully assessed and possibility of pseudolesion should be considered especially when the observations are multiple, cause indentation of gallbladder, and lack ancillary features of malignancy.
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Affiliation(s)
- Amir A Borhani
- Northwestern University Feinberg School of Medicine, Chicago, USA.
| | - Naishal Patel
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Vedang Patel
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - Frank H Miller
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Katrina McGinty
- University of North Carolina at Chapel Hill, Chapel Hill, USA
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Kobayashi S. Hepatic pseudolesions caused by alterations in intrahepatic hemodynamics. World J Gastroenterol 2021; 27:7894-7908. [PMID: 35046619 PMCID: PMC8678815 DOI: 10.3748/wjg.v27.i46.7894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatic pseudolesion may occur in contrast-enhanced computed tomography and magnetic resonance imaging due to the unique haemodynamic characteristics of the liver. The concept of hepatic arterial buffer response (HABR) has become mainstream for the understanding of the mechanism of the reciprocal effect between hepatic arterial and portal venous flow. And HABR is thought to be significantly related to the occurrence of the abnormal imaging findings on arterial phase of contrast enhanced images, such as hepatic arterial-portal vein shunt and transient hepatic attenuation difference, which mimic hypervascular tumor and may cause clinical problems. Third inflow to the liver also cause hepatic pseudolesion, and some of the cases may show histopathologic change such as focal hyperplasia, focal fatty liver, and focal sparing of fatty liver, and called pseudotumor. To understand these phenomena might be valuable for interpreting the liver imaging findings.
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Affiliation(s)
- Satoshi Kobayashi
- Department of Quantum Medical Technology, Kanazawa University Graduate School of Medical Sciences, Kanazawa 9200942, Ishikawa, Japan
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Choi TW, Chung JW, Kim HC, Choi JW, Lee M, Hur S, Jae HJ. Aberrant gastric venous drainage and associated atrophy of hepatic segment II: computed tomography analysis of 2021 patients. Abdom Radiol (NY) 2020; 45:2764-2771. [PMID: 32382821 DOI: 10.1007/s00261-020-02563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the prevalence and patterns of aberrant gastric venous drainage and associated atrophy of the hepatic segment on contrast-enhanced computed tomography (CT). METHODS Two radiologists retrospectively reviewed contrast-enhanced CT images from 2021 patients who underwent cone-beam CT-guided chemoembolization between January 2013 and December 2018. They determined the presence or absence of an aberrant gastric vein(s) and its drainage site by consensus, and qualitatively analyzed the presence or absence of atrophy of segments II or III. In cases of disagreement between the two reviewers regarding the presence of atrophy, quantitative analysis was performed using dedicated software. RESULTS A total of 31 aberrant right gastric veins were revealed on CT (1.5%), most of which drained into P2 (n = 8), the S2/3 border zone (n = 8), S2 (n = 6), or S4 (n = 5). An aberrant left gastric vein was observed in 21 (1.0%) patients, and P2 was the most common drainage site (n = 13) in these patients. Atrophy of segment II was more frequently observed among patients with aberrant gastric veins than among those without (26.9% versus 4.1%; p < 0.001). In addition, an aberrant gastric vein draining into P2 was most frequently accompanied by segment II atrophy (47.6%). CONCLUSION Aberrant right and left gastric veins were observed in 1.5% and 1.0% of patients, respectively. Atrophy of segment II was frequently observed in patients with aberrant gastric veins, especially those that drained into P2.
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Evaluation of hemodynamics in focal steatosis and focal spared lesion of the liver using contrast-enhanced ultrasonography with sonazoid. Radiol Res Pract 2014; 2014:604594. [PMID: 25165582 PMCID: PMC4137544 DOI: 10.1155/2014/604594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 01/22/2023] Open
Abstract
We aim to investigate the hemodynamics in focal steatosis and focal spared lesion of the liver using contrast-enhanced ultrasonography (CEUS) with Sonazoid. The subjects were 47 patients with focal steatosis and focal spared lesion. We evaluated enhancement patterns (hyperenhancement, isoenhancement, and hypoenhancement) in the vascular phase and the presence or absence of a hypoechoic area in the postvascular phase for these lesions using CEUS. Of the 24 patients with focal steatosis, the enhancement pattern was isoenhancement in 19 and hypoenhancement in 5. Hypoechoic areas were noted in the postvascular phase in 3 patients. Of the 23 patients with focal spared lesions, the enhancement pattern was isoenhancement in 18 and hyperenhancement in 5. No hypoechoic areas were noted in the postvascular phase in any patient. The hemodynamics in focal steatosis and focal spared lesions in nondiffuse fatty liver can be observed using low-invasive procedures in real-time by CEUS. It was suggested that differences in the dynamics of enhancement in the vascular phase of CEUS were influenced by the fat deposits in the target lesion, the surrounding liver parenchyma, and the third inflow.
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Kiyosue H, Ibukuro K, Maruno M, Tanoue S, Hongo N, Mori H. Multidetector CT anatomy of drainage routes of gastric varices: a pictorial review. Radiographics 2013; 33:87-100. [PMID: 23322829 DOI: 10.1148/rg.331125037] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Most gastric varices arise at hepatofugal collateral pathways and drain into the systemic vein through one or both of two different types of portosystemic collateral drainage systems: the gastroesophageal (azygous) venous system and the gastrophrenic venous system. The gastroesophageal venous system consists of gastric varices contiguous with esophageal varices, paraesophageal varices, and the azygos vein, which terminates into the superior vena cava. Gastric varices draining through the gastroesophageal venous system can be treated with endoscopic techniques or creation of a transjugular intrahepatic portosystemic shunt. The gastrophrenic venous system consists of the gastric varices and the left inferior phrenic vein (IPV), which terminates into the left renal vein or the inferior vena cava. The left IPV has abundant anastomoses with peridiaphragmatic and retroperitoneal veins, and these anastomoses can function as drainage pathways from gastric varices. Balloon-occluded retrograde transvenous obliteration is a preferred treatment option for this type of gastric varix. Occasionally, gastric varices can form at the hepatopetal collateral pathway that develops secondary to localized portal hypertension caused by splenic vein occlusion. Splenectomy is often required for the treatment of this type of gastric varix. Multidetector computed tomography permits comprehensive evaluation of these venous drainage systems. Familiarity with and assessment of these draining routes of gastric varices are important for selecting treatment options and interventional techniques.
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Affiliation(s)
- Hiro Kiyosue
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita 879-5963, Japan.
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Vilgrain V, Ronot M, Abdel-Rehim M, Zappa M, d’Assignies G, Bruno O, Vullierme MP. Hepatic steatosis: A major trap in liver imaging. Diagn Interv Imaging 2013; 94:713-27. [DOI: 10.1016/j.diii.2013.03.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Eun HW, Kim JH, Hong SS, Kim YJ. Assessment of acute cholangitis by MR imaging. Eur J Radiol 2012; 81:2476-80. [DOI: 10.1016/j.ejrad.2011.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/18/2011] [Accepted: 10/19/2011] [Indexed: 12/07/2022]
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Abstract
BACKGROUND The natural history of nonalcoholic steatohepatitis (NASH) includes the passage through steatosis. GOAL To retrospectively evaluate the usefulness of sonographic parameters compared to histological diagnosis when differentiating steatosis from NASH. STUDY This retrospective study reviewed records of patients with steatosis from databases of our Departments, selecting only those who had been diagnosed by sonography and liver biopsy [64 males (63.82%); 30 females (36.18%)]. RESULTS Attenuation of the echo amplitude (P<0.05; odds ratio (OR): 3.43; confidence interval (CI): 1.02-11.57), focal fat sparing (P<0.05; OR: 3; CI: 1.02-11.88) and splenic diameter (P<0.05; OR: 1.66; CI: 1.04-3.26) were independent predictors of NASH. A significantly higher association of attenuation of the echo amplitude, enlarged splenic diameter, and presence of focal fat sparing was observed in NASH patients (P<0.01). CONCLUSIONS It is very difficult to build a predictive system to distinguish NASH from steatosis based on sonographic scores. However, it is already possible to differentiate NASH from steatosis by combining 3 simple sonographic parameters: attenuation of the echo amplitude, enlarged splenic diameter, and presence of focal fat sparing.
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11
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Radiological and histopathological manifestations of hepatocellular nodular lesions concomitant with various congenital and acquired hepatic hemodynamic abnormalities. Jpn J Radiol 2009; 27:53-68. [PMID: 19373534 DOI: 10.1007/s11604-008-0299-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Accepted: 10/31/2008] [Indexed: 12/25/2022]
Abstract
Congenital and acquired hepatic hemodynamic abnormalities are classified into four categories: hepatic arterial inflow disorder, portal vein inflow disorder, hepatic vein outflow disorder, and presence of a third inflow to the liver. Although their detailed etiology is not fully understood, these hepatic hemodynamic abnormalities may cause the formation of hepatocellular nodules. Recent advances in imaging modalities now enable visualization of these hepatocellular nodules concomitantly with the identification of various congenital and acquired hemodynamic abnormalities. Most of these nodular lesions are benign hyperplastic nodules, such as focal nodular hyperplasia, nodular regenerative hyperplasia, and other types of regenerative nodules. However, neoplastic nodules such as hepatic adenoma and hepatocellular carcinoma may also occur in conjunction with hepatic hemodynamic abnormalities. Distinguishing neoplastic nodules, especially malignant liver tumors, from hyperplastic nodules is important. Detection of intranodular Kupffer cells with superparamagnetic iron oxide enhanced magnetic resonance imaging is a key indicator that a nodule is regenerative rather than neoplastic.
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Namasivayam S, Salman K, Mittal PK, Martin D, Small WC. Hypervascular hepatic focal lesions: spectrum of imaging features. Curr Probl Diagn Radiol 2007; 36:107-23. [PMID: 17484954 DOI: 10.1067/j.cpradiol.2006.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Detection and characterization of liver lesions often present a diagnostic challenge to the radiologists. Liver lesions may be classified as hypovascular and hypervascular based on degree of hepatic arterial blood supply. Common hypervascular liver lesions include hemangioma, focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma, fibrolamellar carcinoma, and metastases from primary tumors such as islet cell tumor, carcinoid, renal cell carcinoma, melanoma, and thyroid carcinoma. In this review article, we discuss the spectrum of imaging features of hypervascular liver lesions.
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Affiliation(s)
- Saravanan Namasivayam
- Division of Abdominal Imaging, Department of Radiology, Emory University Hospital, Atlanta, GA 30322, USA
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Gabata T, Matsui O, Terayama N, Kobayashi S, Sanada J. Imaging diagnosis of hepatic metastases of pancreatic carcinomas: significance of transient wedge-shaped contrast enhancement mimicking arterioportal shunt. ACTA ACUST UNITED AC 2007; 33:437-43. [PMID: 17610105 DOI: 10.1007/s00261-007-9280-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We aimed to evaluate the imaging findings of hepatic metastases from pancreatic cancers, especially wedge-shaped enhancement and its etiology. Dynamic CT and MR images were performed in 87 patients with liver metastases from pancreatic carcinomas, and CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) in 51 patients. Liver metastases were multiple in 84 patients (97%) and solitary in only three (3%). In 44 of 87 patients (51%), all liver metastases showed ring-like enhancement compatible with metastatic adenocarcinomas on dynamic CT and/or dynamic MR imaging. In 37 patients, more than one metastatic lesion showed wedge-shaped contrast enhancement on dynamic CT, dynamic MRI and CTHA, and wedge-shaped perfusion defect on CTAP adjacent to metastatic tumors. Six patients showed multiple wedge-shaped enhancements, which were initially diagnosed as multiple arterioportal shunts (AP shunts). However, metastatic tumors appeared within the area of wedge-shaped enhancement and increased in size on follow-up CT and/or MR images. After all, 43 of 87 patients (49%) had AP shunt like contrast enhancement adjacent to liver metastases. Liver metastases from pancreatic carcinomas frequently show transient wedge-shaped enhancement, and should not be misdiagnosed as nontumorous arterioportal shunts.
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Affiliation(s)
- Toshifumi Gabata
- Department of Radiology, Kanazawa University, School of Medical Science, 13-1 Takara-machi, Kanazawa City, 920-8641, Japan.
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Miyayama S, Matsui O, Taki K, Minami T, Ryu Y, Ito C, Nakamura K, Inoue D, Takamatsu S. Arterial blood supply to the posterior aspect of segment IV of the liver from the caudate branch: demonstration at CT after iodized oil injection. Radiology 2005; 237:1110-4. [PMID: 16251397 DOI: 10.1148/radiol.2373041660] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To retrospectively evaluate the arterial blood supply to the posterior aspect of segment IV of the liver with computed tomography (CT) after transcatheter arterial chemoembolization (TACE) with iodized oil through the caudate arterial branch of the liver for treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS Institutional review board approval and patient informed consent were not required for this retrospective study. Twenty-four patients (11 men and 13 women; mean age, 68 years) with HCC originating in the caudate lobe (n = 23) or posterior aspect of segment IV (n = 1) were selected. TACE of the caudate arterial branch was performed in all patients, including one patient with HCC in the posterior aspect of segment IV who underwent TACE of the caudate arterial branch after CT helped confirm that iodized oil was not distributed in the tumor after TACE of the medial segmental artery. The distribution of iodized oil in the posterior aspect of segment IV was analyzed with CT 1 week after TACE. The number and origin of all arteries supplying the caudate lobe and the number of arteries embolized were determined. RESULTS Thirty-three caudate arterial branches were embolized. Twenty-nine branches were derived from the right hepatic artery and four were derived from the left hepatic artery. A single branch was seen in 17 patients, two branches were seen in five, and three branches were seen in two. Eight patients simultaneously underwent additional TACE of branches of the right hepatic artery (n = 6) or right inferior phrenic artery (n = 2). At CT, iodized oil was seen to be distributed entirely (n = 19) or partially (n = 5) in the caudate lobe. Distribution of iodized oil at the posterior aspect of segment IV was observed in 16 patients (67%), including 13 (54%) whose caudate arterial branches were derived entirely from the right hepatic artery. CONCLUSION The results of this study suggest that the caudate arterial branch, which is mainly derived from the right hepatic artery, frequently supplies the posterior aspect of segment IV. This knowledge is important for managing HCC in the posterior aspect of segment IV by means of TACE.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
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Loukas M, Louis RG, Hullett J, Loiacano M, Skidd P, Wagner T. An anatomical classification of the variations of the inferior phrenic vein. Surg Radiol Anat 2005; 27:566-74. [PMID: 16172871 DOI: 10.1007/s00276-005-0029-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 05/05/2005] [Indexed: 12/13/2022]
Abstract
The majority of anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic vein (IPV). However, in the last decade, an increasing number of reports have arisen, with reference to the endoscopic embolization of esophageal and paraesophageal varices, as well as venous drainage of hepatocellular carcinomas (HCC). The IPV is one of the major sources of collateral venous drainage in portal hypertension and HCC. The aim of this study was to identify the origin and distribution of the IPVs (right and left), both in normal and (selective) pathological cases. We have examined 300 formalin-fixed adult cadavers, without any visible gastrointestinal disease, and 30 cadavers derived from patients with HCC. The right IPV drained into the following: the inferior vena cava (IVC) inferior to the diaphragm in 90%, the right hepatic vein in 8%, and the IVC superior to the diaphragm in 2%. The left IPV drained into the following: the IVC inferior to the diaphragm in 37%, the left suprarenal vein in 25%, the left renal vein in 15%, the left hepatic vein in 14%, and both the IVC and the left adrenal vein in 1% of the specimens. The IPVs possessed four notable tributaries: anterior, esophageal, lateral and medial. The right IPV served as one of the major extrahepatic draining veins for all 30 cases of HCC. These findings could have potential clinical implications in the transcatheter embolization of esophageal and paraesophageal varices, as well as in mobilizing the supradiaphragmatic segment of IVC.
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Affiliation(s)
- Marios Loukas
- Department of Anatomy, American University of the Caribbean, Jordan Road, Cupecoy, Lowlands, Sint Maarten, Netherlands Antilles.
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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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Affiliation(s)
- Haesun Choi
- Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Terayama N, Matsui O, Tatsu H, Gabata T, Kinoshita A, Hasatani K. Focal sparing of fatty liver in segment II associated with aberrant left gastric vein. Br J Radiol 2004; 77:150-2. [PMID: 15010390 DOI: 10.1259/bjr/86102770] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a patient with aberrant left gastric vein (LGV) that directly enters the posterior edge of segment II in the liver. The corresponding area was focally spared of fatty liver. We consider that this aberrant LGV contributed to the cause of focal sparing. This is the first report of the use of helical CT and Doppler ultrasound to depict the aberrant LGV that directly enters the liver.
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Affiliation(s)
- N Terayama
- Department of Radiology, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
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Arai K, Kawai K, Kohda W, Tatsu H, Matsui O, Nakahama T. Dynamic CT of acute cholangitis: early inhomogeneous enhancement of the liver. AJR Am J Roentgenol 2003; 181:115-8. [PMID: 12818840 DOI: 10.2214/ajr.181.1.1810115] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our objective was to describe the dynamic CT findings of acute cholangitis, especially early inhomogeneous enhancement of hepatic parenchyma. MATERIALS AND METHODS Inhomogeneous enhancement of hepatic parenchyma was retrospectively evaluated on dynamic CT in 406 consecutive patients without irregular fatty liver or multiple hepatic tumors. Dynamic CT scans were obtained 30 sec (early phase) and 90 sec (late phase) after starting the contrast material injection. Thirteen patients were diagnosed as having acute cholangitis (cholangitis group), and the remaining 393 patients were classified as the control group. The frequency of inhomogeneous enhancement was compared between these two groups. In nine of the 13 patients in the cholangitis group, we also evaluated changes in inhomogeneous enhancement on follow-up dynamic CT scans obtained after the patients had undergone treatment for acute cholangitis. RESULTS In the cholangitis group, 11 (85%) of 13 patients showed nodular, patchy, wedge-shaped, or geographic inhomogeneous enhancement throughout the liver in the early phase on dynamic CT. In the control group, 19 (5%) of 393 patients also showed inhomogeneous enhancement in the early phase on dynamic CT. The frequency of inhomogeneous enhancement was significantly higher in the cholangitis group than in the control group (p < 0.001). Follow-up dynamic CT performed after treatment for acute cholangitis showed decreased inhomogeneous enhancement or no inhomogeneous enhancement in seven (78%) of nine patients in the cholangitis group. CONCLUSION Inhomogeneous enhancement in the early phase on dynamic CT is frequently seen in patients with acute cholangitis; this finding usually disappears after treatment.
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Affiliation(s)
- Kazunori Arai
- Department of Radiology, Kurobe City Hospital, 1108-1 Mikkaichi, Kurobe 938-0031, Japan
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Krinsky GA, Lee VS, Theise ND, Weinreb JC, Morgan GR, Diflo T, John D, Teperman LW, Goldenberg AS. Transplantation for hepatocellular carcinoma and cirrhosis: sensitivity of magnetic resonance imaging. Liver Transpl 2002; 8:1156-64. [PMID: 12474156 DOI: 10.1053/jlts.2002.35670] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The sensitivity of magnetic resonance imaging (MRI) in patients who undergo transplantation for hepatocellular carcinoma (HCC) and cirrhosis is not known. We prospectively evaluated 24 patients with known HCC who underwent MRI and subsequent transplantation within 60 days (mean, 20 days). Using a phased-array coil at 1.5T, breath-hold turbo STIR and T2-weighted MR images were performed. Dynamic gadolinium-enhanced MRI was performed using a two- or three-dimensional gradient echo pulse sequence with images obtained in the hepatic arterial, portal venous, and equilibrium phases. The prospective interpretation of the MR study was directly compared with thin-section pathology evaluation of the explanted livers. All 24 patients had at least one HCC, and MR diagnosed tumor in 21 (88%) of these patients. On a lesion-by-lesion basis, MRI depicted 39 of 118 HCC for an overall sensitivity of 33%. MRI detected five (100%) of five lesions >5 cm, 20 (100%) of 20 lesions >2 cm but not exceeding 5 cm, 11 (52%) of 21 lesions between 1 and 2 cm, and three (4%) of 72 lesions <1 cm. Of the nine patients with carcinomatosis (innumerable lesions less than 1 cm), MR detected three lesions in one patient. Of the 15 dysplastic nodules found at pathology, MRI depicted a single 1.8-cm high-grade lesion, for a sensitivity of 7%. In conclusion, MRI is sensitive for the detection of HCC measuring at least 2 cm in diameter but is insensitive for the diagnosis of small HCC (<2 cm) and carcinomatosis.
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Affiliation(s)
- Glenn A Krinsky
- Department of Radiology, New York University Medical Center, New York, NY 10016, USA.
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer death worldwide. Numerous surgical and nonsurgical treatment options are available for treating patients with HCC. Successful long-term outcome is dependent on early detection and accurate delineation of the number and location of tumor nodules. Noninvasive imaging modalities, including ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, are commonly used in the initial evaluation of these patients. Herein, the authors present the different manifestations of HCC with these imaging modalities and the role of imaging in the follow-up of patients after nonsurgical treatment.
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Affiliation(s)
- Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 N. Wolfe Street, Room 100, Baltimore, MD 21287, USA.
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Krinsky GA, Lee VS, Theise ND, Weinreb JC, Rofsky NM, Diflo T, Teperman LW. Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology 2001; 219:445-54. [PMID: 11323471 DOI: 10.1148/radiology.219.2.r01ma40445] [Citation(s) in RCA: 229] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the sensitivity and specificity of magnetic resonance (MR) imaging for detection of hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) by using explantation correlation in patients with cirrhosis and no known HCC. MATERIALS AND METHODS Seventy-one patients without a known history of HCC who underwent MR imaging and subsequent transplantation within 90 days were examined. Breath-hold turbo short inversion time inversion-recovery and/or T2-weighted turbo spin-echo MR images were obtained. Dynamic two- or three-dimensional gadolinium-enhanced gradient-echo MR images were obtained in the hepatic arterial, portal venous, and equilibrium phases. Prospective MR image interpretations were compared directly with explanted liver pathologic results. RESULTS Eleven (15%) of 71 patients had hepatic malignancies; MR imaging enabled diagnosis of tumor in six (54%) of 11 patients. On a lesion-by-lesion basis, MR imaging depicted 11 of 20 hepatic neoplasms, for an overall sensitivity of 55%. MR imaging depicted four (80%) of five lesions larger than 2 cm, six (50%) of 12 lesions 1-2 cm, and one (33%) of three lesions smaller than 1 cm. MR imaging depicted only nine (15%) of 59 DNS: The specificities of MR imaging for detection of HCC and DNs on a per patient basis were 60 (86%) of 70 patients and 53 (85%) of 62 patients, respectively. CONCLUSION MR imaging is insensitive for the diagnosis of small (<2-cm) HCCs and DNS:
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Affiliation(s)
- G A Krinsky
- Department of Radiology, New York University Medical Center, 530 First Ave, New York, NY 10016, USA.
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Choi D, Choo SW, Lim JH, Lee SJ, Do YS, Choo IW. Opacification of the intrahepatic portal veins during CT hepatic arteriography. J Comput Assist Tomogr 2001; 25:218-24. [PMID: 11242216 DOI: 10.1097/00004728-200103000-00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to ascertain the cause of opacification of the portal veins during CT hepatic arteriography (CTHA). METHOD A total of 155 consecutive patients with hepatocellular carcinoma were evaluated with CTHA as preoperative staging. The opacification of the portal veins during CTHA was categorized as opacification of the main portal vein, right or left branches of the main portal vein (generalized), and segmental or subsegmental portal veins (localized). Hepatic angiography was compared and possible causes were evaluated. RESULTS One hundred eight (70%) of 155 patients showed intrahepatic portal vein opacification at CTHA: generalized in 60 patients (39%) and localized in 48 patients (31%). Intrahepatic causes were arterioportal shunts due to hepatocellular carcinoma in 20 (19% of 108 patients), previous liver biopsy in 9 (8%), and portal vein thrombosis in 4 (4%). Extrahepatic cause was counted in 57 cases (53%) and was due to inflow of contrast material via nonmesenteric portal circulation through the gastric antrum, duodenum, and/or pancreas. CONCLUSION Intrahepatic portal veins are frequently opacified during CTHA, and the causes were arterioportal shunts through hepatocellular carcinoma, postbiopsy shunt, portal vein thrombosis, and inflow of contrast material via the nonmesenteric portal circulation.
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Affiliation(s)
- D Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Quiroga S, Sebastià C, Pallisa E, Castellà E, Pérez-Lafuente M, Alvarez-Castells A. Improved diagnosis of hepatic perfusion disorders: value of hepatic arterial phase imaging during helical CT. Radiographics 2001; 21:65-81; questionnaire 288-94. [PMID: 11158645 DOI: 10.1148/radiographics.21.1.g01ja0165] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The liver has a unique dual blood supply, which makes helical computed tomography (CT) a highly suitable technique for hepatic imaging. Helical CT allows single breath-hold scanning without motion artifacts. Because of rapid image acquisition, two-phase (hepatic arterial phase and portal venous phase) evaluation of the hepatic parenchyma is possible, improving tumor detection and tumor characterization in a single CT study. The arterial and portal venous supplies to the liver are not independent systems. There are several communications between the vessels, including transsinusoidal, transvasal, and transplexal routes. When vascular compromise occurs, there are often changes in the volume of blood flow in individual vessels and even in the direction of blood flow. These perfusion disorders can be detected with helical CT and are generally seen as an area of high attenuation on hepatic arterial phase images that returns to normal on portal venous phase images; this finding reflects increased arterial blood flow and arterioportal shunting in most cases. Familiarity with the helical CT appearances of these perfusion disorders will result in more accurate diagnosis. By recognizing these perfusion disorders, false-positive diagnosis (hypervascular tumors) or overestimation of the size of liver tumors (eg, hepatocellular carcinoma) can be avoided.
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Affiliation(s)
- S Quiroga
- Department of Radiology and Institut de Diagnòstic per la Imatge, Hospital General Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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Yamagami T, Nakamura T, Kin Y, Nishimura T. Non-tumorous enhancement caused by cholecystic venous inflow shown on biphasic CT hepatic arteriography: comparison with hepatocellular carcinoma. Br J Radiol 2000; 73:1275-81. [PMID: 11205671 DOI: 10.1259/bjr.73.876.11205671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The haemodynamics in non-tumorous abnormalities on CT arterial portography (CTAP) owing to cholecystic venous direct inflow to the liver were compared with the haemodynamics in hepatocellular carcinoma. 53 patients who simultaneously underwent CTAP and CT during hepatic arteriography (CTHA) to detect hepatocellular carcinoma had the late phase added to CTHA. Changes in size, shape and pattern of 47 non-tumorous enhancement abnormalities on the liver around the gall bladder or in the dorsum of segment IV between the early and late phases on biphasic CTHA as well as of 60 tumorous lesions were determined. Enhancement on biphasic CTHA was seen in all 47 lesions with a non-tumorous portal defect (early phase alone, n=8; late phase alone, n = 3; both, n = 36). In these 47 lesions, the size and the shape of enhancement changed in 63.8% and 51.1%, respectively, between the early and late phases on CTHA; the pattern of enhancement did not change in 72.3%. On the other hand, the size of enhancement on biphasic CTHA changed in only 16.7% of 60 tumours, and the shape in only 5%, although the enhancement pattern changed in a large proportion (80%). In conclusion, owing to the difference in haemodynamics, non-tumorous abnormalities caused by cholecystic venous inflow and tumours are clearly delineated on biphasic CTHA. Thus, adding the late phase to previous single phase CTHA (i.e. performing biphasic CTHA) is useful in differentiating the two entities.
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Affiliation(s)
- T Yamagami
- Department of Radiology, Kyoto Prefectural University of Medicine, Kamigyo, Japan
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Yamagami T, Arai Y, Inaba Y, Matsueda K, Takeuchi Y, Nishimura T. The aetiology of non-tumorous enhancement in the hepatic hilum shown on CT hepatic arteriography. Br J Radiol 2000; 73:727-32. [PMID: 11089463 DOI: 10.1259/bjr.73.871.11089463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The causes of non-tumorous abnormalities in the hepatic hilum seen on CT hepatic arteriography were investigated. 13 patients with non-tumorous defects of portal perfusion in the hepatic hilum on CT arterial portography underwent both CT hepatic arteriography from the common hepatic artery and CT obtained during proper hepatic arteriography. The findings of non-tumorous portal defects on these two angiographic studies using helical CT were compared. In the 13 patients, 14 non-tumorous defects of portal perfusion in the hepatic hilum on CT arterial portography were detected as enhanced areas in 10 regions (dorsum of segment IV, 7/10; dorsum of the lateral segment, 3/4) on CT hepatic arteriography via the common hepatic artery, but none were enhanced on CT obtained during proper hepatic arteriography. In conclusion, the main cause of non-tumorous enhancement in the hepatic hilum seen on CT hepatic arteriography is non-portal direct inflow via the parabiliary venous system.
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Affiliation(s)
- T Yamagami
- Department of Diagnostic Radiology, Aichi Cancer Center, Japan
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Yamagami T, Takeuchi Y, Inaba Y, Matsueda K, Arai Y, Maeda T. Correlation of a defect of portal perfusion in the dorsal part of segment IV of the liver on CT arterial portography with inflow of the aberrant pancreaticoduodenal vein. Br J Radiol 1999; 72:552-5. [PMID: 10560336 DOI: 10.1259/bjr.72.858.10560336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The correlation between an aberrant pancreaticoduodenal vein and a portal perfusion defect in the dorsal part of segment IV as demonstrated on CT arterial portography (CTAP) was investigated. 14 patients with non-tumorous defects of portal perfusion in the dorsal part of segment IV of the liver parenchyma, shown on CTAP underwent CT during pancreaticoduodenal arteriography. The defect on CTAP was shown as an enhanced area resulting from non-portal venous inflow in eight (57%) of 14 patients on CT during pancreaticoduodenal arteriography. In conclusion, the non-portal venous supply via an aberrant pancreaticoduodenal vein occasionally causes a defect of portal perfusion in the dorsal part of segment IV on CT arterial portography.
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Affiliation(s)
- T Yamagami
- Department of Diagnostic Radiology, Aichi Cancer Center, Japan
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Yoon KH, Matsui O, Kadoya M, Yoshigawa J, Gabata T, Arai K. Pseudolesion in segments II and III of the liver on CT during arterial portography caused by aberrant right gastric venous drainage. J Comput Assist Tomogr 1999; 23:306-9. [PMID: 10096343 DOI: 10.1097/00004728-199903000-00024] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We report three cases of pseudolesions caused by aberrant right gastric venous drainage (AGVD) in segment II/III of the liver as demonstrated on CT during arterial portography (CTAP). On CTAP, the lesions were seen as wedge-shaped perfusion defects, and on hepatic arteriography, AGVD directed to the area with the perfusion defect was visible in all three cases. When a perfusion defect is detected at the edge of segments II/III at CTAP, a pseudolesion caused by AGVD should be suspected.
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Affiliation(s)
- K H Yoon
- Department of Radiology, Kanazawa University School of Medicine, Japan
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Ueda K, Matsui O, Kadoya M, Yoshikawa J, Gabata T, Takahashi S, Kawamori Y, Takashima T. Pseudolesion in segment IV of the liver on MRI: prevalence and morphology in 250 cirrhotic livers compared with 250 normal livers. J Comput Assist Tomogr 1999; 23:63-8. [PMID: 10050810 DOI: 10.1097/00004728-199901000-00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The goal of our study was to assess the prevalence of pseudolesion in segment IV of the liver on MRI in patients with and without liver cirrhosis. METHOD Patients were divided into three groups: 10 patients with angiographically confirmed aberrant gastric venous drainage and liver cirrhosis (Group 1), 250 consecutively selected patients with liver cirrhosis (Group 2), and 250 with normal liver (Group 3). The signal intensity of pseudolesion in segment IV on T1- and T2-weighted MRI in the 510 patients was analyzed. RESULTS In Group 1, five pseudolesions were visible and hyperintense on T1-weighted images. On T2-weighted images, four were visible and hypointense. In Group 2, 11 were seen (4.4%). All were hyperintense on T1-weighted images. Five were hypointense on T2-weighted images. In Group 3, one pseudolesion was seen (0.4%). CONCLUSION The prevalence of pseudolesion in segment IV on MRI is higher in liver cirrhosis than in normal liver. The lesion is hyperintense on T1-weighted images when visible.
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Affiliation(s)
- K Ueda
- Department of Radiology, Kanazawa University School of Medicine, Japan
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Pameijer FA, Mancuso AA, Mendenhall WM, Parsons JT, Mukherji SK, Hermans R, Kubilis PS. Evaluation of pretreatment computed tomography as a predictor of local control in T1/T2 pyriform sinus carcinoma treated with definitive radiotherapy. Head Neck 1998; 20:159-68. [PMID: 9484948 DOI: 10.1002/(sici)1097-0347(199803)20:2<159::aid-hed10>3.0.co;2-h] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study was undertaken to determine whether pretreatment computed tomography (CT) findings can predict local control in pyriform sinus carcinoma treated with definitive radiotherapy (RT). METHODS Twenty-three patients with pyriform sinus carcinoma (T1: n = 5; T2: n = 18) were treated with high-dose RT and followed for a minimum of 2 years. Tumor volumes and extent were determined on pretreatment CT studies. The specific CT parameters assessed were analyzed as predictors of local control. RESULTS There was a significant decrease in local control rate for tumors over 6.5 mL (1 of 4 [25%]) relative to tumors under 6.5 mL (17 of 19 [89%]; p = .021). Sensitivity and specificity for local control using this cutoff were 94% and 60%, respectively. Tumor score, as a measure of anatomic extent, was also found to be a significant predictor of local control (p = .033). The local control rate was not influenced significantly by the presence of "minimal" apex disease (< 10 mm in greatest dimensions as measured on CT) but decreased significantly when "bulk" apex disease (> OR = 10 mm) was present (p = .027). Laryngeal cartilage sclerosis was not a significant predictor of outcome. CONCLUSION Computed tomography can stratify pyriform sinus carcinomas into groups more or less likely to be locally controlled with definitive RT.
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Affiliation(s)
- F A Pameijer
- Department of Radiology, University of Florida College of Medicine/Shands Hospital, Gainesville 32610, USA
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Abstract
MRI is a powerful tool in the detection and characterization of both focal and diffuse liver pathology. Because of superior soft tissue characterization, direct multi-planar capabilities and lack of ionizing radiation, current state of the art MRI is useful when contrast CT is relatively contraindicated or not definitive. This article reviews the MRI findings of the most common focal and diffuse liver diseases encountered in clinical practice. Reviews of current MR techniques and MR contrast agents used in liver imaging have been recently published. For this article, discussion of specific techniques and use of contrast is addressed for each pathological entity discussed.
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Affiliation(s)
- E S Siegelman
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA
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Affiliation(s)
- R D Redvanly
- Department of Radiology, Emory School of Medicine, Atlanta, GA 30322, USA
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